Provider Demographics
NPI:1851627657
Name:ILARDO, MICHAEL J (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:ILARDO
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 1:10419 PINE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH COLLINS
Mailing Address - State:NY
Mailing Address - Zip Code:14111-9405
Mailing Address - Country:US
Mailing Address - Phone:716-337-2530
Mailing Address - Fax:
Practice Address - Street 1:1234 ABBOTT RD
Practice Address - Street 2:SUITE #210
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1944
Practice Address - Country:US
Practice Address - Phone:716-768-2500
Practice Address - Fax:716-768-3355
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist