Provider Demographics
NPI:1356938385
Name:KAMINSKI, MICHAEL ADAM (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ADAM
Last Name:KAMINSKI
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 1:3736 N BAY HORSE LOOP
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1982
Mailing Address - Country:US
Mailing Address - Phone:314-681-2120
Mailing Address - Fax:
Practice Address - Street 1:6484 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5620
Practice Address - Country:US
Practice Address - Phone:520-297-8397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist