Provider Demographics
NPI:1477281400
Name:FEDASH-MICHALSKI, KYRA ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:KYRA
Middle Name:ANN
Last Name:FEDASH-MICHALSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-1553
Mailing Address - Country:US
Mailing Address - Phone:973-886-7078
Mailing Address - Fax:973-585-7081
Practice Address - Street 1:2 BERGEN TPKE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660-2390
Practice Address - Country:US
Practice Address - Phone:908-241-6337
Practice Address - Fax:908-241-4034
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01872200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist