Provider Demographics
NPI:1023867074
Name:MCMICHAEL, PHILIP JOHN II
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOHN
Last Name:MCMICHAEL
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67725 QUIJO RD
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-5555
Mailing Address - Country:US
Mailing Address - Phone:760-219-7509
Mailing Address - Fax:
Practice Address - Street 1:68010 VISTA CHINO
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3660
Practice Address - Country:US
Practice Address - Phone:760-325-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist