Healthcare Provider Details

I. General information

NPI: 1093298184
Provider Name (Legal Business Name): MINGO FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MCLISTER AVE
MINGO JUNCTION OH
43938-1259
US

IV. Provider business mailing address

116 MCLISTER AVE
MINGO JUNCTION OH
43938-1259
US

V. Phone/Fax

Practice location:
  • Phone: 740-438-5857
  • Fax:
Mailing address:
  • Phone: 740-438-5857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA LOUISE VOSTATEK
Title or Position: OWNER
Credential: PHARMD
Phone: 740-438-5857