Provider Demographics
NPI:1083014336
Name:HOWARD, MICKI (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICKI
Middle Name:
Last Name:HOWARD
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 1:1168 W BRANCH ST
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1906
Mailing Address - Country:US
Mailing Address - Phone:805-474-0900
Mailing Address - Fax:805-474-8947
Practice Address - Street 1:1168 W BRANCH ST
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1906
Practice Address - Country:US
Practice Address - Phone:805-474-0900
Practice Address - Fax:805-474-8947
Is Sole Proprietor?:No
Enumeration Date:2014-08-23
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist