Provider Demographics
NPI:1386938454
Name:PANZARELLA, MICHAEL D
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:PANZARELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9669 MENTOR AVE # 17388
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4528
Mailing Address - Country:US
Mailing Address - Phone:440-210-5054
Mailing Address - Fax:440-210-5064
Practice Address - Street 1:9669 MENTOR AVE
Practice Address - Street 2:T-2322
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4528
Practice Address - Country:US
Practice Address - Phone:440-210-5054
Practice Address - Fax:440-210-5064
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03226519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist