Provider Demographics
NPI:1265519169
Name:CHUNDERLIK, GEORGE MICHAEL
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MICHAEL
Last Name:CHUNDERLIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 TRILLIUM CT
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-3335
Mailing Address - Country:US
Mailing Address - Phone:724-772-3454
Mailing Address - Fax:
Practice Address - Street 1:968 PERRY HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2148
Practice Address - Country:US
Practice Address - Phone:412-635-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032066L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist