Provider Demographics
NPI:1417030875
Name:MICKLOW, ALEXANDER J (RPH)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:J
Last Name:MICKLOW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656-1334
Mailing Address - Country:US
Mailing Address - Phone:724-842-1771
Mailing Address - Fax:724-845-7897
Practice Address - Street 1:165 MARKET ST
Practice Address - Street 2:
Practice Address - City:LEECHBURG
Practice Address - State:PA
Practice Address - Zip Code:15656-1334
Practice Address - Country:US
Practice Address - Phone:724-842-1771
Practice Address - Fax:724-845-7897
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029083L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist