Provider Demographics
NPI:1134407729
Name:MISSAKIAN, MICHAEL G (PHARMD/PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:MISSAKIAN
Suffix:
Gender:M
Credentials:PHARMD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SANTA ROSA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-7621
Mailing Address - Country:US
Mailing Address - Phone:707-578-1711
Mailing Address - Fax:707-578-6287
Practice Address - Street 1:1900 SANTA ROSA AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-7621
Practice Address - Country:US
Practice Address - Phone:707-578-1711
Practice Address - Fax:707-578-6287
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist