Provider Demographics
NPI:1942359575
Name:DEBALKO, MICHELLE ALBANO (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ALBANO
Last Name:DEBALKO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:MCADOO
Mailing Address - State:PA
Mailing Address - Zip Code:18237-1741
Mailing Address - Country:US
Mailing Address - Phone:570-929-3218
Mailing Address - Fax:570-929-1208
Practice Address - Street 1:322 S HANCOCK ST
Practice Address - Street 2:
Practice Address - City:MCADOO
Practice Address - State:PA
Practice Address - Zip Code:18237-1608
Practice Address - Country:US
Practice Address - Phone:570-929-2338
Practice Address - Fax:570-929-1208
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029990L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP029990LOtherPHARMACIST LICENSE