Healthcare Provider Details

I. General information

NPI: 1851611552
Provider Name (Legal Business Name): MICHAEL ROBERT MACOSKO R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GRACE ST.
PITTSBURGH PA
15211
US

IV. Provider business mailing address

201 GRACE ST.
PITTSBURGH PA
15211
US

V. Phone/Fax

Practice location:
  • Phone: 412-381-1464
  • Fax: 412-381-2473
Mailing address:
  • Phone: 412-381-1464
  • Fax: 412-381-2473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP028542L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: