Provider Demographics
NPI:1760749410
Name:HA, MICKY (RPH)
Entity Type:Individual
Prefix:
First Name:MICKY
Middle Name:
Last Name:HA
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 1:2633 LITER DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1732
Mailing Address - Country:US
Mailing Address - Phone:443-574-4263
Mailing Address - Fax:253-276-9686
Practice Address - Street 1:2855 SMITH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1426
Practice Address - Country:US
Practice Address - Phone:410-484-3200
Practice Address - Fax:410-484-1882
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20291183500000X
NY056550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist