Provider Demographics
NPI:1053717579
Name:BLASZCZYK, CHAD RICHARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:RICHARD
Last Name:BLASZCZYK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 ADMIRAL DR UNIT 307
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8152
Mailing Address - Country:US
Mailing Address - Phone:814-440-1563
Mailing Address - Fax:
Practice Address - Street 1:2601 RIVA RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7304
Practice Address - Country:US
Practice Address - Phone:814-440-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist