Healthcare Provider Details

I. General information

NPI: 1598328627
Provider Name (Legal Business Name): CARLY GRMEK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLY MALIVUK PHARMD

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 TRINITY PL
MISHAWAKA IN
46545-5006
US

IV. Provider business mailing address

1540 TRINITY PL
MISHAWAKA IN
46545-5006
US

V. Phone/Fax

Practice location:
  • Phone: 412-427-8280
  • Fax:
Mailing address:
  • Phone: 412-427-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRP451718
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: