Provider Demographics
NPI:1467821645
Name:MIKANIK, SADAF (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SADAF
Middle Name:
Last Name:MIKANIK
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 1:13059 LAMIA PT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6928
Mailing Address - Country:US
Mailing Address - Phone:619-243-6527
Mailing Address - Fax:
Practice Address - Street 1:13059 LAMIA PT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-6928
Practice Address - Country:US
Practice Address - Phone:619-243-6527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist