Provider Demographics
NPI:1649609710
Name:MICHALAK, GINA MARIE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:MICHALAK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:EGLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:379 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335
Mailing Address - Country:US
Mailing Address - Phone:814-337-0582
Mailing Address - Fax:
Practice Address - Street 1:379 NORTH STREET
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335
Practice Address - Country:US
Practice Address - Phone:814-337-0582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP447983183500000X
OHRPH.03232736-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist