Provider Demographics
NPI:1669606257
Name:MALISHEWSKY, MICHAEL JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MALISHEWSKY
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 1:1204 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-2405
Mailing Address - Country:US
Mailing Address - Phone:252-444-0910
Mailing Address - Fax:252-444-0721
Practice Address - Street 1:2032 WATERSCAPE WAY
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562
Practice Address - Country:US
Practice Address - Phone:252-631-5234
Practice Address - Fax:252-631-5233
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14010OtherBOP