Provider Demographics
NPI:1669075784
Name:PODRASKY, MICHAEL C (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:PODRASKY
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 1:17229 N VILLAGE MAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-6311
Mailing Address - Country:US
Mailing Address - Phone:302-644-1558
Mailing Address - Fax:302-644-2290
Practice Address - Street 1:17229 N VILLAGE MAIN BLVD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6311
Practice Address - Country:US
Practice Address - Phone:302-644-1558
Practice Address - Fax:302-644-2290
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0002650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist