Provider Demographics
NPI:1518062314
Name:MITRINGA, SLAVKO O (RPH)
Entity Type:Individual
Prefix:MR
First Name:SLAVKO
Middle Name:O
Last Name:MITRINGA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1317
Mailing Address - Country:US
Mailing Address - Phone:201-746-0525
Mailing Address - Fax:201-746-0525
Practice Address - Street 1:809 FRANKLIN LAKES RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-2113
Practice Address - Country:US
Practice Address - Phone:201-891-4810
Practice Address - Fax:201-891-9661
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02383000183500000X
NY042964-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist