Provider Demographics
NPI:1932693645
Name:MIHALICK, SANDRA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:MIHALICK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1612
Mailing Address - Country:US
Mailing Address - Phone:570-724-4461
Mailing Address - Fax:
Practice Address - Street 1:24 EAST AVE
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1612
Practice Address - Country:US
Practice Address - Phone:570-724-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist