Healthcare Provider Details

I. General information

NPI: 1033793815
Provider Name (Legal Business Name): MARGO MISHIC RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2021
Last Update Date: 05/08/2021
Certification Date: 05/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 EAST AVE
AKRON OH
44314-2233
US

IV. Provider business mailing address

2147 EAST AVE
AKRON OH
44314-2233
US

V. Phone/Fax

Practice location:
  • Phone: 330-753-5021
  • Fax: 330-753-4816
Mailing address:
  • Phone: 330-753-5021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17754
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: