Provider Demographics
NPI:1760114904
Name:DRAGONFLY HOSPICE PHARMACY
Entity Type:Organization
Organization Name:DRAGONFLY HOSPICE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PHARMACY SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:412-403-4301
Mailing Address - Street 1:264 SMITH TOWNSHIP STATE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:BURGETTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15021-2124
Mailing Address - Country:US
Mailing Address - Phone:724-414-1425
Mailing Address - Fax:855-445-4203
Practice Address - Street 1:1710 UNDERPASS WAY STE 301
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6975
Practice Address - Country:US
Practice Address - Phone:855-358-7220
Practice Address - Fax:833-734-1175
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRAGONFLY HOSPICE PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-27
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy