Healthcare Provider Details

I. General information

NPI: 1518449214
Provider Name (Legal Business Name): CARLEY MINGONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MARKET ST
ELIZABETH PA
15037
US

IV. Provider business mailing address

705 PARK AVE
WEST MIFFLIN PA
15122
US

V. Phone/Fax

Practice location:
  • Phone: 412-384-2890
  • Fax:
Mailing address:
  • Phone: 412-708-3038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452577
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: