Healthcare Provider Details

I. General information

NPI: 1700174406
Provider Name (Legal Business Name): MICHAEL J SQUICCIARINO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 08/10/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180
US

IV. Provider business mailing address

CMR 402 BOX 1637
APO AE
09180-0017
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-5222
  • Fax:
Mailing address:
  • Phone: 208-648-4438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60228895
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: