Provider Demographics
NPI:1952462665
Name:MICKLOSKY, CHARLES JOSEPH JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:MICKLOSKY
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1489 SANBROOK CT
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-5645
Mailing Address - Country:US
Mailing Address - Phone:610-865-3370
Mailing Address - Fax:610-865-3370
Practice Address - Street 1:1489 SANBROOK CT
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-5645
Practice Address - Country:US
Practice Address - Phone:610-865-3370
Practice Address - Fax:610-865-3370
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP025502L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist