Provider Demographics
NPI:1407486749
Name:MIKA, KRISTAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTAN
Middle Name:
Last Name:MIKA
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 1:18900 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48174-9566
Mailing Address - Country:US
Mailing Address - Phone:734-941-2067
Mailing Address - Fax:734-941-2903
Practice Address - Street 1:18900 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48174-9566
Practice Address - Country:US
Practice Address - Phone:734-941-2067
Practice Address - Fax:734-941-2903
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist