Basic Information
| Provider Information | |||||||||
| NPI: | 1558698324 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICALE | ||||||||
| FirstName: | EDITH | ||||||||
| MiddleName: | TORTORA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARM.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7855 BOULEVARD E | ||||||||
| Address2: | APARTMENT 7C | ||||||||
| City: | NORTH BERGEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070475938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016620623 | ||||||||
| FaxNumber: | 2016620672 | ||||||||
| Practice Location | |||||||||
| Address1: | 7855 BOULEVARD E | ||||||||
| Address2: | APARTMENT 7C | ||||||||
| City: | NORTH BERGEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070475938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016620623 | ||||||||
| FaxNumber: | 2016620672 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2009 | ||||||||
| LastUpdateDate: | 11/15/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 28R101158600 | NJ | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.