Provider Demographics
NPI:1588049290
Name:MIKACH, JUSTIN
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:MIKACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 SERRANO AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-2053
Mailing Address - Country:US
Mailing Address - Phone:724-875-2804
Mailing Address - Fax:
Practice Address - Street 1:100 MALL DR
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-3092
Practice Address - Country:US
Practice Address - Phone:740-266-7199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH.03334305-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist