Provider Demographics
NPI:1932868924
Name:MICHAEL, PETER G (BPHARM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 ELFORD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-3622
Mailing Address - Country:US
Mailing Address - Phone:215-547-1082
Mailing Address - Fax:
Practice Address - Street 1:521 ELFORD RD
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-3622
Practice Address - Country:US
Practice Address - Phone:215-547-1082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03415500183500000X
FLPS34205183500000X
PARP045745L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist