Provider Demographics
NPI:1255784526
Name:DEBARBA, MIKAELA DAWN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MIKAELA
Middle Name:DAWN
Last Name:DEBARBA
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 1:201 FM 685
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-8045
Mailing Address - Country:US
Mailing Address - Phone:512-251-9037
Mailing Address - Fax:
Practice Address - Street 1:201 FM 685
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-8045
Practice Address - Country:US
Practice Address - Phone:512-251-9037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist