Individual
MR. MALLA MITTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1524 10TH ST, PORT HURON, MI 48060-5815
(810) 982-3100
(810) 982-3106
Mailing address
1524 10TH ST, PORT HURON, MI 48060-5815
(810) 982-3100
(810) 982-3106
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302038531
MI
Other
Enumeration date
07/01/2021
Last updated
07/01/2021
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