Provider Demographics
NPI:1003419524
Name:MASTROIANNI, MICHAEL FRANCIS
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:MASTROIANNI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 DOVE TER
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9712
Mailing Address - Country:US
Mailing Address - Phone:908-334-2593
Mailing Address - Fax:
Practice Address - Street 1:5829 TILGHMAN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9129
Practice Address - Country:US
Practice Address - Phone:610-398-3228
Practice Address - Fax:610-530-1815
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032406L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist