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General NPI Number Information
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NPI Number | 1710260930
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH CRIVELLARO PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 1510 MILSTEAD AVE NE
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City | CONYERS
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State | GA
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Zip | 30012-8030
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Country | US
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Telephone | 770-785-7128
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Fax | 770-785-7257
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Provider Business Mailing Address
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Address Line | 195 HAZELHURST DR
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City | COVINGTON
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State | GA
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Zip | 30016-1322
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Country | US
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Telephone | 678-296-7893
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH016826
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License Number State | GA
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