Provider Demographics
NPI:1205030798
Name:O'HARA, MICHAEL M (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:O'HARA
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 1:1248 DECEMBER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505
Mailing Address - Country:US
Mailing Address - Phone:570-344-7140
Mailing Address - Fax:
Practice Address - Street 1:10 TRIEBLE DR
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-7025
Practice Address - Country:US
Practice Address - Phone:570-836-2273
Practice Address - Fax:570-836-2274
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP0408756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist