Provider Demographics
NPI:1508468455
Name:SIKOD, MACGILAND
Entity Type:Individual
Prefix:
First Name:MACGILAND
Middle Name:
Last Name:SIKOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 SKINNER DR
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-3146
Mailing Address - Country:US
Mailing Address - Phone:443-469-8972
Mailing Address - Fax:
Practice Address - Street 1:4320 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-6906
Practice Address - Country:US
Practice Address - Phone:254-751-0301
Practice Address - Fax:254-751-0306
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist