Provider Demographics
NPI:1700036472
Name:MISSAL, BARBARA KELLY (BCNP RPH)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:KELLY
Last Name:MISSAL
Suffix:
Gender:F
Credentials:BCNP RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 LA MONTAGE DR
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-4060
Mailing Address - Country:US
Mailing Address - Phone:610-824-6917
Mailing Address - Fax:
Practice Address - Street 1:1000 E MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0027
Practice Address - Country:US
Practice Address - Phone:570-826-7702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038377L1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist