Individual
MISCHA PESICEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2745 AMERICAN LEGION BLVD, MOUNTAIN HOME, ID 83647-3185
(208) 587-0861
Mailing address
6848 STATE ROUTE 14, RAVENNA, OH 44266-9401
(330) 221-6543
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
03333644
OH
183500000X
Pharmacist
24599
NC
183500000X
Pharmacist
55370
TX
183500000X
Pharmacist
Primary
P7417
ID
Other
Enumeration date
04/21/2016
Last updated
04/21/2016
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