Provider Demographics
NPI:1609154053
Name:MIHELICH, SAM A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:A
Last Name:MIHELICH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-5332
Mailing Address - Country:US
Mailing Address - Phone:336-224-0424
Mailing Address - Fax:336-224-0434
Practice Address - Street 1:1250 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-5332
Practice Address - Country:US
Practice Address - Phone:336-224-0424
Practice Address - Fax:336-224-0434
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22094183500000X
OH03330889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0295913Medicaid