Provider Demographics
NPI:1497036875
Name:MACHEN, MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MACHEN
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 1:3781 MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1557
Mailing Address - Country:US
Mailing Address - Phone:315-487-5775
Mailing Address - Fax:315-487-4423
Practice Address - Street 1:240 TOWNSHIP BLVD STE 30
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1793
Practice Address - Country:US
Practice Address - Phone:315-487-5775
Practice Address - Fax:315-487-4423
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445828183500000X
NY059088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist