Provider Demographics
NPI:1710958889
Name:MIKHAEEL, MERY EWAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MERY
Middle Name:EWAN
Last Name:MIKHAEEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:MERY
Other - Middle Name:EWAN
Other - Last Name:MIKHAEEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:13934 CHANCELLOR WAY
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5804
Mailing Address - Country:US
Mailing Address - Phone:858-679-6943
Mailing Address - Fax:
Practice Address - Street 1:13934 CHANCELLOR WAY
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-5804
Practice Address - Country:US
Practice Address - Phone:858-679-6943
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist