Provider Demographics
NPI:1013254069
Name:MIKLAVCIC, ANGELA KAYE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAYE
Last Name:MIKLAVCIC
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 1:606 HAVENDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-4687
Mailing Address - Country:US
Mailing Address - Phone:863-551-9798
Mailing Address - Fax:863-551-9829
Practice Address - Street 1:606 HAVENDALE BLVD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4687
Practice Address - Country:US
Practice Address - Phone:863-551-9798
Practice Address - Fax:863-551-9829
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist