Healthcare Provider Details

I. General information

NPI: 1306390984
Provider Name (Legal Business Name): MICHELLE MEJIBOVSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 MAGILL DR
NORTH HUNTINGDON PA
15642-3992
US

IV. Provider business mailing address

827 MAGILL DR
NORTH HUNTINGDON PA
15642-3992
US

V. Phone/Fax

Practice location:
  • Phone: 724-861-7201
  • Fax:
Mailing address:
  • Phone: 724-861-7201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number449944
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: