Provider Demographics
NPI:1750780763
Name:MICHALSKI, JUSTIN BERNARD (PHARMD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:BERNARD
Last Name:MICHALSKI
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 1:1215 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3156
Mailing Address - Country:US
Mailing Address - Phone:919-946-7765
Mailing Address - Fax:
Practice Address - Street 1:2401 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4717
Practice Address - Country:US
Practice Address - Phone:803-796-8126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist