Provider Demographics
NPI:1225012107
Name:MIHULKA, SCOTT ALAN (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALAN
Last Name:MIHULKA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 NE 11TH ST
Mailing Address - Street 2:B109
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4534
Mailing Address - Country:US
Mailing Address - Phone:425-637-4926
Mailing Address - Fax:
Practice Address - Street 1:653 156TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4823
Practice Address - Country:US
Practice Address - Phone:425-641-9127
Practice Address - Fax:425-641-9108
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00039643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist