Provider Demographics
NPI:1356808299
Name:DRAGONFLY HOSPICE PHARMACY
Entity type:Organization
Organization Name:DRAGONFLY HOSPICE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PHARMACY OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:724-414-1425
Mailing Address - Street 1:264 SMITH TOWNSHIP STATE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:BURGETTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15021-2124
Mailing Address - Country:US
Mailing Address - Phone:724-414-1425
Mailing Address - Fax:855-445-4203
Practice Address - Street 1:5075 WINDFALL RD # 253
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8613
Practice Address - Country:US
Practice Address - Phone:330-952-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy