Provider Demographics
NPI:1285230193
Name:CHABORA, MICHAEL WALTER (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WALTER
Last Name:CHABORA
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 1:82 BLUEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1049
Mailing Address - Country:US
Mailing Address - Phone:201-394-7623
Mailing Address - Fax:201-599-1009
Practice Address - Street 1:250 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-1719
Practice Address - Country:US
Practice Address - Phone:202-262-8838
Practice Address - Fax:201-599-1009
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02364100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist