Provider Demographics
NPI:1205460391
Name:MCCUISTION, MICAH JAMES (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:JAMES
Last Name:MCCUISTION
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-8808
Mailing Address - Country:US
Mailing Address - Phone:214-463-8085
Mailing Address - Fax:
Practice Address - Street 1:2200 FM 663
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5600
Practice Address - Country:US
Practice Address - Phone:469-336-2041
Practice Address - Fax:469-336-2044
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX512201835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist