Provider Demographics
NPI:1053459255
Name:MUSTOVIC, FAITHANN MARIAN (RPH)
Entity type:Individual
Prefix:MRS
First Name:FAITHANN
Middle Name:MARIAN
Last Name:MUSTOVIC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 CONRAD DR
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-4010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EVANS CITY
Practice Address - State:PA
Practice Address - Zip Code:16033-1219
Practice Address - Country:US
Practice Address - Phone:724-538-4240
Practice Address - Fax:724-538-3826
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036637L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP036637LOtherPHARMACY LICENSE