Provider Demographics
NPI:1962003319
Name:MIRABELLI, CARLO (RPH)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:MIRABELLI
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 1:3606 MOFFAT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-6250
Mailing Address - Country:US
Mailing Address - Phone:143-453-1054
Mailing Address - Fax:
Practice Address - Street 1:WAL-MART
Practice Address - Street 2:1028C RICHMOND AVE.
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401
Practice Address - Country:US
Practice Address - Phone:540-886-4208
Practice Address - Fax:540-886-6205
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty