Provider Demographics
NPI:1497920235
Name:KONDIK, MICHAEL A (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:KONDIK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BIRCH ST
Mailing Address - Street 2:BUILDING B, SUITE 100
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3585
Mailing Address - Country:US
Mailing Address - Phone:800-225-5967
Mailing Address - Fax:909-799-4364
Practice Address - Street 1:25 BIRCH ST
Practice Address - Street 2:BUILDING B, SUITE 100
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3585
Practice Address - Country:US
Practice Address - Phone:800-225-5967
Practice Address - Fax:909-799-4364
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist