Provider Demographics
NPI:1184246589
Name:MIKUS, MICHELLE J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:J
Last Name:MIKUS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 THORNCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-1532
Mailing Address - Country:US
Mailing Address - Phone:412-403-4301
Mailing Address - Fax:
Practice Address - Street 1:100 PARK MANOR DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-1012
Practice Address - Country:US
Practice Address - Phone:724-414-1425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233406183500000X
WVRP0010640183500000X
PARP448182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist