Provider Demographics
NPI:1871179788
Name:RALSTON, MICHELE ANNE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANNE
Last Name:RALSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-6584
Mailing Address - Country:US
Mailing Address - Phone:724-322-8893
Mailing Address - Fax:
Practice Address - Street 1:511 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:CONFLUENCE
Practice Address - State:PA
Practice Address - Zip Code:15424-1048
Practice Address - Country:US
Practice Address - Phone:814-395-5300
Practice Address - Fax:814-395-5676
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031307L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist