Provider Demographics
NPI:1558698324
Name:MICALE, EDITH TORTORA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:TORTORA
Last Name:MICALE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 BOULEVARD E
Mailing Address - Street 2:APARTMENT 7C
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5938
Mailing Address - Country:US
Mailing Address - Phone:201-662-0623
Mailing Address - Fax:201-662-0672
Practice Address - Street 1:7855 BOULEVARD E
Practice Address - Street 2:APARTMENT 7C
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5938
Practice Address - Country:US
Practice Address - Phone:201-662-0623
Practice Address - Fax:201-662-0672
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-15
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R1011586001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist