Provider Demographics
NPI:1164909438
Name:NAKAGAWA, MICAH
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:NAKAGAWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 WAYZATA BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1372
Mailing Address - Country:US
Mailing Address - Phone:952-746-8185
Mailing Address - Fax:
Practice Address - Street 1:8441 WAYZATA BLVD STE 340
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1372
Practice Address - Country:US
Practice Address - Phone:952-746-8185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist