Provider Demographics
NPI:1366531188
Name:HRICINAK, MICHAEL J (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:HRICINAK
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 1:4630 MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-2004
Mailing Address - Country:US
Mailing Address - Phone:267-218-1446
Mailing Address - Fax:215-785-6453
Practice Address - Street 1:4630 MURRAY ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-2004
Practice Address - Country:US
Practice Address - Phone:267-218-1446
Practice Address - Fax:215-785-6453
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035089L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP035089LOtherPHARMACIST LICENSE