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General NPI Number Information
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NPI Number | 1821760877
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Entity Type | Individual
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Provider Name | ELIZABETH E MIELNICKI
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Gender | Female
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 1163 PROVIDENCE RD
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City | WHITINSVILLE
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State | MA
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Zip | 01588-2119
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Country | US
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Telephone | 734-150-8234
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 471
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City | DOUGLAS
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State | MA
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Zip | 01516-0471
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Country | US
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Telephone | 774-482-0500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH240396
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License Number State | MA
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