Provider Demographics
NPI:1265777817
Name:CHUPKA, MICHAEL N (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:N
Last Name:CHUPKA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 ALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1923
Mailing Address - Country:US
Mailing Address - Phone:732-735-9208
Mailing Address - Fax:
Practice Address - Street 1:2007 N BELFAST AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4363
Practice Address - Country:US
Practice Address - Phone:207-622-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-09
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR12611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist