Provider Demographics
NPI:1285449538
Name:MINER, MIKAELA (PHARMD)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:MINER
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 1:350 PATTESON DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3232
Mailing Address - Country:US
Mailing Address - Phone:304-599-8316
Mailing Address - Fax:304-241-6090
Practice Address - Street 1:350 PATTESON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3232
Practice Address - Country:US
Practice Address - Phone:304-599-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0014322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist