Individual
MARK MITTLESTAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
31320 FIVE MILE RD, LIVONIA, MI 48154-3680
(734) 427-3430
Mailing address
31320 FIVE MILE RD, LIVONIA, MI 48154-3680
(734) 427-3430
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302022896
MI
Other
Enumeration date
07/29/2018
Last updated
07/29/2018
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