MEDICARE: MICHELLE S STASKA 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	17829	CO

General Provider Information

NPI Number	:	1306148333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE S STASKA PHARMD

Provider Business Mailing Address
First Line	:	3318 APOGEE VW
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4046
Country	:	US
Telephone Number	:	719-358-9432
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 S NEVADA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-3407
Country	:	US
Telephone Number	:	719-636-5257
Fax Number	:

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

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	11/24/2010

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