Provider Demographics
NPI:1740655059
Name:CHENEY, MIKALLA (PHARMD)
Entity type:Individual
Prefix:
First Name:MIKALLA
Middle Name:
Last Name:CHENEY
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 1:6169 NE RADFORD DR APT 1514
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7983
Mailing Address - Country:US
Mailing Address - Phone:206-516-9668
Mailing Address - Fax:
Practice Address - Street 1:6169 NE RADFORD DR APT 1514
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7983
Practice Address - Country:US
Practice Address - Phone:206-516-9668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60574219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist