Provider Demographics
NPI:1508636465
Name:MICHAYEL, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MICHAYEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 CONO DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-7777
Mailing Address - Country:US
Mailing Address - Phone:619-368-5113
Mailing Address - Fax:
Practice Address - Street 1:8694 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-2828
Practice Address - Country:US
Practice Address - Phone:619-460-5978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist