Provider Demographics
NPI:1013296342
Name:BAGLIO, ATHENA C (RPH, MBA)
Entity type:Individual
Prefix:MRS
First Name:ATHENA
Middle Name:C
Last Name:BAGLIO
Suffix:
Gender:F
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 ROUSER RD
Mailing Address - Street 2:BLDG 4, SUITE 503
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2773
Mailing Address - Country:US
Mailing Address - Phone:412-672-1073
Mailing Address - Fax:412-672-0643
Practice Address - Street 1:333 ROUSER RD
Practice Address - Street 2:BLDG 4, SUITE 503
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2773
Practice Address - Country:US
Practice Address - Phone:412-672-1073
Practice Address - Fax:412-672-0643
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041033L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist