Provider Demographics
NPI:1700296662
Name:AIOSA, MARIO ANGELO (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:ANGELO
Last Name:AIOSA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:34399 BLAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3144
Mailing Address - Country:US
Mailing Address - Phone:586-415-6164
Mailing Address - Fax:586-415-6165
Practice Address - Street 1:30800 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-1700
Practice Address - Country:US
Practice Address - Phone:586-415-6164
Practice Address - Fax:586-415-6165
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI53020274221835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy