Provider Demographics
NPI:1710579834
Name:PACIA, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PACIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 QUEENS PLZ S
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4102
Mailing Address - Country:US
Mailing Address - Phone:718-269-7385
Mailing Address - Fax:
Practice Address - Street 1:2726 QUEENS PLZ S
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4102
Practice Address - Country:US
Practice Address - Phone:718-269-7385
Practice Address - Fax:718-269-7386
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist