Provider Demographics
NPI:1225307127
Name:MIKAELIAN, MICHELE (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MIKAELIAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 USHER ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-8148
Mailing Address - Country:US
Mailing Address - Phone:917-612-3725
Mailing Address - Fax:
Practice Address - Street 1:245 AMITY RD
Practice Address - Street 2:SUITE 111
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2258
Practice Address - Country:US
Practice Address - Phone:917-612-3725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist