Provider Demographics
NPI:1134724990
Name:GASKIN, MICHAELA JADE
Entity type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:JADE
Last Name:GASKIN
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 1:6181 US HIGHWAY 431
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-2011
Mailing Address - Country:US
Mailing Address - Phone:256-878-3502
Mailing Address - Fax:256-878-3846
Practice Address - Street 1:6181 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-2011
Practice Address - Country:US
Practice Address - Phone:256-878-3502
Practice Address - Fax:256-878-3846
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist