Provider Demographics
NPI:1447430772
Name:MIKOLIN, DENNIS PETER (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:PETER
Last Name:MIKOLIN
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 1:441 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1029
Mailing Address - Country:US
Mailing Address - Phone:716-828-1508
Mailing Address - Fax:
Practice Address - Street 1:441 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1029
Practice Address - Country:US
Practice Address - Phone:716-828-1508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-03
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist