MEDICARE: MICHAEL A. KONDIK R.PH.

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	23459	MA

General Provider Information

NPI Number	:	1497920235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A. KONDIK R.PH.

Provider Business Mailing Address
First Line	:	25 BIRCH ST
Second Line	:	BUILDING B, SUITE 100
City	:	MILFORD
State	:	MA
Zip	:	01757-3585
Country	:	US
Telephone Number	:	800-225-5967
Fax Number	:	909-799-4364

Provider Business Practice Location Address
First Line	:	25 BIRCH ST
Second Line	:	BUILDING B, SUITE 100
City	:	MILFORD
State	:	MA
Zip	:	01757-3585
Country	:	US
Telephone Number	:	800-225-5967
Fax Number	:	909-799-4364

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

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/29/2008

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