Provider Demographics
NPI:1972265759
Name:MIKHAEL, WALAA (PHARMD)
Entity Type:Individual
Prefix:
First Name:WALAA
Middle Name:
Last Name:MIKHAEL
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 1:556 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4386
Mailing Address - Country:US
Mailing Address - Phone:718-384-7901
Mailing Address - Fax:718-218-8591
Practice Address - Street 1:556 GRAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-4386
Practice Address - Country:US
Practice Address - Phone:718-384-7901
Practice Address - Fax:718-218-8591
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty