MEDICARE: MRS. FAITHANN MARIAN MUSTOVIC 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	RP036637L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP036637L	OTHER	PA	PHARMACY LICENSE

General Provider Information

NPI Number	:	1053459255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FAITHANN MARIAN MUSTOVIC R.PH.

Provider Business Mailing Address
First Line	:	460 CONRAD DR
Second Line	:
City	:	MARS
State	:	PA
Zip	:	16046-4010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E MAIN ST
Second Line	:
City	:	EVANS CITY
State	:	PA
Zip	:	16033-1219
Country	:	US
Telephone Number	:	724-538-4240
Fax Number	:	724-538-3826

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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