Provider Demographics
NPI:1407528391
Name:MCCALLION, MICHELLE ANNE (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNE
Last Name:MCCALLION
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 1:606 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-6002
Mailing Address - Country:US
Mailing Address - Phone:814-734-5036
Mailing Address - Fax:814-734-7299
Practice Address - Street 1:606 ERIE ST
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-6002
Practice Address - Country:US
Practice Address - Phone:814-734-5036
Practice Address - Fax:814-734-7299
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037545L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist