Provider Demographics
NPI:1801336284
Name:CHURILLA, MICHAEL FRANCIS (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:CHURILLA
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 1:4000 HEMPFIELD PLAZA BLVD
Mailing Address - Street 2:STE 966
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-1483
Mailing Address - Country:US
Mailing Address - Phone:724-836-8412
Mailing Address - Fax:724-836-8414
Practice Address - Street 1:4000 HEMPFIELD PLAZA BLVD
Practice Address - Street 2:STE 966
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1483
Practice Address - Country:US
Practice Address - Phone:724-836-8412
Practice Address - Fax:724-836-8414
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029968L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011733930003Medicaid