Provider Demographics
NPI:1851013395
Name:MIEHLKE, NICHOLAS RAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RAY
Last Name:MIEHLKE
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 1:15023 DUXBURY LN
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-9321
Mailing Address - Country:US
Mailing Address - Phone:517-927-9939
Mailing Address - Fax:
Practice Address - Street 1:5125 W SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2635
Practice Address - Country:US
Practice Address - Phone:517-886-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist