Provider Demographics
NPI:1477832285
Name:MICHALSKI, FRED J (RPH, MS)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:J
Last Name:MICHALSKI
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 POCONO COMMONS
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-8170
Mailing Address - Country:US
Mailing Address - Phone:570-426-1044
Mailing Address - Fax:570-426-1044
Practice Address - Street 1:350 POCONO COMMONS
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-8170
Practice Address - Country:US
Practice Address - Phone:570-426-1044
Practice Address - Fax:570-426-1044
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-030170-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist