Provider Demographics
NPI:1356837561
Name:PISKURIC, MICHAEL MARK III (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MARK
Last Name:PISKURIC
Suffix:III
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 1:134 SADDLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071-3726
Mailing Address - Country:US
Mailing Address - Phone:814-421-3624
Mailing Address - Fax:
Practice Address - Street 1:134 SADDLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:PA
Practice Address - Zip Code:15071-3726
Practice Address - Country:US
Practice Address - Phone:814-421-3624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist