Active NPI
Michael D. Revilak, PHARMD
- Pharmacist
- Moosic, PA
National Provider Identifier
1356327779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP043637L
- Practice address
- 3382 Birney PLZ
Moosic, PA 18507-1560 - Phone
- (570) 904-6042
- NPI assigned
- Dec 17, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP043637L | PA | Primary |
Addresses
Primary practice location
3382 Birney PLZ
Moosic, PA 18507-1560
Mailing address
1422 N Lincoln Ave
Scranton, PA 18508-1817
Phone (570) 815-1652
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP043637L | PA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748217600000",
"number": "1356327779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1422 N LINCOLN AVE",
"city": "SCRANTON",
"state": "PA",
"postal_code": "185081817",
"telephone_number": "570-815-1652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3382 BIRNEY PLZ",
"city": "MOOSIC",
"state": "PA",
"postal_code": "185071560",
"telephone_number": "570-904-6042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVILAK",
"first_name": "MICHAEL",
"middle_name": "D.",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-17",
"last_updated": "2025-05-26",
"certification_date": "2025-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP043637L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moosic, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.