Provider Demographics
NPI:1053798355
Name:BIALASZEWSKI, MICAH JOHN
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:JOHN
Last Name:BIALASZEWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 ROUTE 332
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14620
Mailing Address - Country:US
Mailing Address - Phone:585-742-1910
Mailing Address - Fax:585-742-2809
Practice Address - Street 1:1259 ROUTE 332
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-8915
Practice Address - Country:US
Practice Address - Phone:585-742-1910
Practice Address - Fax:585-742-2809
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist