Provider Demographics
NPI:1144993403
Name:CHACHKO, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CHACHKO
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 1:2716 BUSHNELL CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:OH
Mailing Address - Zip Code:44418-9728
Mailing Address - Country:US
Mailing Address - Phone:330-856-0550
Mailing Address - Fax:
Practice Address - Street 1:2840 YOUNGSTOWN RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-5063
Practice Address - Country:US
Practice Address - Phone:330-369-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-31
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist