Provider Demographics
NPI:1487856332
Name:SANNICOLAS, MICHELLE THERESE AGUIGUI (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:THERESE AGUIGUI
Last Name:SANNICOLAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:SAN NICOLAS
Other - Last Name:DELOSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:128 ATIS CT
Mailing Address - Street 2:
Mailing Address - City:SANTA RITA
Mailing Address - State:GU
Mailing Address - Zip Code:96915-1512
Mailing Address - Country:US
Mailing Address - Phone:671-565-5191
Mailing Address - Fax:
Practice Address - Street 1:#162 AS APMAN DRIVE
Practice Address - Street 2:INARAJAN COMMUNITY HEALTH CENTER
Practice Address - City:INARAJAN
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-828-7501
Practice Address - Fax:671-828-7504
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPH092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist