Provider Demographics
NPI:1881293090
Name:MIKHAEL, VIVIAN FARID (PHARMD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:FARID
Last Name:MIKHAEL
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 1:2610 W THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-5948
Mailing Address - Country:US
Mailing Address - Phone:602-993-9900
Mailing Address - Fax:602-993-7824
Practice Address - Street 1:2610 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-5948
Practice Address - Country:US
Practice Address - Phone:602-993-9900
Practice Address - Fax:602-993-7824
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist