Healthcare Provider Details

I. General information

NPI: 1235996919
Provider Name (Legal Business Name): ULTAN MCGLONE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 5TH AVE
MCKEESPORT PA
15132-2422
US

IV. Provider business mailing address

100 LEON RD
PITTSBURGH PA
15220-3219
US

V. Phone/Fax

Practice location:
  • Phone: 412-664-2262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP451321
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: