Provider Demographics
NPI:1437704749
Name:MITTATHANY, MERRILL J (PHARMD)
Entity Type:Individual
Prefix:
First Name:MERRILL
Middle Name:J
Last Name:MITTATHANY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 WOODHAVEN TER
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2413
Mailing Address - Country:US
Mailing Address - Phone:215-410-9715
Mailing Address - Fax:
Practice Address - Street 1:51 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-9442
Practice Address - Country:US
Practice Address - Phone:610-358-9725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist