MEDICARE: DR. MICHAEL N CHUPKA PHARMD

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	PR12611	ME

General Provider Information

NPI Number	:	1265777817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL N CHUPKA PHARMD

Provider Business Mailing Address
First Line	:	298 ALDEN AVE
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-1923
Country	:	US
Telephone Number	:	732-735-9208
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 N BELFAST AVE
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-4363
Country	:	US
Telephone Number	:	207-622-2626
Fax Number	:

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

Provider Enumeration Date	:	12/09/2012
Last Update Date	:	12/09/2012

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