Provider Demographics
NPI:1679915912
Name:PRUSACZYK, MICHELLE OLA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:OLA
Last Name:PRUSACZYK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 NOTT ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2622
Mailing Address - Country:US
Mailing Address - Phone:518-598-6976
Mailing Address - Fax:
Practice Address - Street 1:1519 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2622
Practice Address - Country:US
Practice Address - Phone:518-598-6976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist