Basic Information
| Provider Information | |||||||||
| NPI: | 1760669089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BILKO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | GERARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 W OLD COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | HICKSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118014011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164334400 | ||||||||
| FaxNumber: | 5164338043 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 W OLD COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | HICKSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118014011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164334400 | ||||||||
| FaxNumber: | 5164338043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2008 | ||||||||
| LastUpdateDate: | 01/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 033726 | NY | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 00895574 | 05 | NY | MEDICAID |