Provider Demographics
NPI:1700104312
Name:MUTO, ELIZABETH E
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:MUTO
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 1:136 MCDONALD DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5644
Mailing Address - Country:US
Mailing Address - Phone:724-814-1112
Mailing Address - Fax:
Practice Address - Street 1:1701 DUNCAN AVE
Practice Address - Street 2:RITE AID
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-2865
Practice Address - Country:US
Practice Address - Phone:412-364-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040960L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist