Provider Demographics
NPI:1154611788
Name:ROSSIK, MICHAEL F (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:F
Last Name:ROSSIK
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 1:348 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-1728
Mailing Address - Country:US
Mailing Address - Phone:508-752-1911
Mailing Address - Fax:508-752-3553
Practice Address - Street 1:348 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-1728
Practice Address - Country:US
Practice Address - Phone:508-752-1911
Practice Address - Fax:508-752-3553
Is Sole Proprietor?:No
Enumeration Date:2011-04-16
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist