Provider Demographics
NPI:1891013132
Name:KATZ, MICHAEL LEONARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEONARD
Last Name:KATZ
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 1:3 SANDIE LN
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2020
Mailing Address - Country:US
Mailing Address - Phone:781-639-4456
Mailing Address - Fax:
Practice Address - Street 1:52 BOSTON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2538
Practice Address - Country:US
Practice Address - Phone:781-581-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist