Provider Demographics
NPI:1487194031
Name:FOX, MICHAEL J (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:FOX
Suffix:
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 1:199 OLD EAST END BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAR CREEK TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18702-9678
Mailing Address - Country:US
Mailing Address - Phone:570-703-8090
Mailing Address - Fax:570-703-8496
Practice Address - Street 1:1800 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2369
Practice Address - Country:US
Practice Address - Phone:570-703-8090
Practice Address - Fax:570-703-8496
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist