Provider Demographics
NPI:1033383732
Name:WITALEC, PAULA IRENE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:IRENE
Last Name:WITALEC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 WILDMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-7621
Mailing Address - Country:US
Mailing Address - Phone:215-639-1502
Mailing Address - Fax:215-639-1502
Practice Address - Street 1:6901 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3209
Practice Address - Country:US
Practice Address - Phone:215-482-7900
Practice Address - Fax:215-482-4894
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039650R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist