Provider Demographics
NPI:1134565633
Name:PASQUAL, MICHAEL J (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:PASQUAL
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 1:15126 KERCHEVAL AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1360
Mailing Address - Country:US
Mailing Address - Phone:313-822-0100
Mailing Address - Fax:313-822-0101
Practice Address - Street 1:15126 KERCHEVAL AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1360
Practice Address - Country:US
Practice Address - Phone:313-822-0100
Practice Address - Fax:313-822-0101
Is Sole Proprietor?:No
Enumeration Date:2013-05-12
Last Update Date:2013-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020229601835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy