Provider Demographics
NPI:1487268322
Name:LUSSIER, MIA ELIZABETH (RPH)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:ELIZABETH
Last Name:LUSSIER
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 1:1180 CEDAR HEAD RD
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:PA
Mailing Address - Zip Code:18249-3518
Mailing Address - Country:US
Mailing Address - Phone:508-493-5424
Mailing Address - Fax:
Practice Address - Street 1:499 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3602
Practice Address - Country:US
Practice Address - Phone:570-714-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist