Provider Demographics
NPI:1093005175
Name:MIELOCH, LORISSA (RPH)
Entity Type:Individual
Prefix:
First Name:LORISSA
Middle Name:
Last Name:MIELOCH
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 1:500 E LANCASTER AVE
Mailing Address - Street 2:RITE AID 290
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-1365
Mailing Address - Country:US
Mailing Address - Phone:610-775-0307
Mailing Address - Fax:610-775-1654
Practice Address - Street 1:500 E LANCASTER AVE
Practice Address - Street 2:RITE AID 290
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1365
Practice Address - Country:US
Practice Address - Phone:610-775-0307
Practice Address - Fax:610-775-1654
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038237L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist