Provider Demographics
NPI:1518243930
Name:MIHELIC, JOHN IVICA (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:IVICA
Last Name:MIHELIC
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 1:33079 GARFIELD RD # 121
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-1859
Mailing Address - Country:US
Mailing Address - Phone:519-987-4307
Mailing Address - Fax:
Practice Address - Street 1:31100 GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-3902
Practice Address - Country:US
Practice Address - Phone:586-294-5729
Practice Address - Fax:586-294-8566
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist