Provider Demographics
NPI:1093696320
Name:MICKLER, ALYSSA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MICKLER
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 1:16400 US HIGHWAY 331 S
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-4190
Mailing Address - Country:US
Mailing Address - Phone:850-835-2317
Mailing Address - Fax:
Practice Address - Street 1:16400 US HIGHWAY 331 S
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439-4190
Practice Address - Country:US
Practice Address - Phone:850-835-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL69557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist