Provider Demographics
NPI:1730461518
Name:PANCHECK, MARK EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:PANCHECK
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 1:221 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-1165
Mailing Address - Country:US
Mailing Address - Phone:989-288-6886
Mailing Address - Fax:989-288-0302
Practice Address - Street 1:221 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1165
Practice Address - Country:US
Practice Address - Phone:989-288-6886
Practice Address - Fax:989-288-0302
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist