Healthcare Provider Details

I. General information

NPI: 1538770581
Provider Name (Legal Business Name): ELLIS PAUL MIRONE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MARKET ST
ELIZABETH PA
15037
US

IV. Provider business mailing address

5600 WILKINS AVE
PITTSBURGH PA
15217-1212
US

V. Phone/Fax

Practice location:
  • Phone: 412-384-2890
  • Fax:
Mailing address:
  • Phone: 412-521-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP454564
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: