Provider Demographics
NPI:1508048042
Name:MANCHIK, STEVEN MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:MANCHIK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:STEVEN
Other - Middle Name:MICHAEL
Other - Last Name:MANCHIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1934 STATE ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-8310
Mailing Address - Country:US
Mailing Address - Phone:845-292-4114
Mailing Address - Fax:845-292-1147
Practice Address - Street 1:1934 STATE ROUTE 52
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-8310
Practice Address - Country:US
Practice Address - Phone:845-292-4114
Practice Address - Fax:845-292-1147
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00521348Medicaid