Provider Demographics
NPI:1326429945
Name:REILLY-MISCAVAGE, MICHELE (PHARM D)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:REILLY-MISCAVAGE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1760
Mailing Address - Country:US
Mailing Address - Phone:570-760-3367
Mailing Address - Fax:
Practice Address - Street 1:299 LAUREL LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1760
Practice Address - Country:US
Practice Address - Phone:570-760-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045614L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist