Provider Demographics
NPI:1790365377
Name:LADA, MIKAELA
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:LADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 W STATE HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4753
Mailing Address - Country:US
Mailing Address - Phone:830-626-3348
Mailing Address - Fax:
Practice Address - Street 1:1655 W STATE HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4753
Practice Address - Country:US
Practice Address - Phone:830-626-3348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician