MEDICARE: MICHAEL JOSEPH ZRADA RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP-031009-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP-031009-L	OTHER	PA	STATE LICENSE

General Provider Information

NPI Number	:	1881911220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOSEPH ZRADA RPH

Provider Business Mailing Address
First Line	:	200 W RIDGE PIKE
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-3702
Country	:	US
Telephone Number	:	610-828-1274
Fax Number	:	610-828-0248

Provider Business Practice Location Address
First Line	:	200 W RIDGE PIKE
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-3702
Country	:	US
Telephone Number	:	610-828-1274
Fax Number	:	610-828-0248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	04/26/2010

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