Provider Demographics
NPI:1730597972
Name:ADAMCZYK, DALE A (RPH)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:A
Last Name:ADAMCZYK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-2507
Mailing Address - Country:US
Mailing Address - Phone:414-762-2610
Mailing Address - Fax:414-571-4130
Practice Address - Street 1:2414 10TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-2507
Practice Address - Country:US
Practice Address - Phone:414-762-2610
Practice Address - Fax:414-571-4130
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10046-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist