Provider Demographics
NPI:1588442115
Name:MIKHAIEL, NANCY R (PHARMD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:R
Last Name:MIKHAIEL
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 1:4400 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3235
Mailing Address - Country:US
Mailing Address - Phone:951-218-4471
Mailing Address - Fax:
Practice Address - Street 1:2288 S GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-5645
Practice Address - Country:US
Practice Address - Phone:909-993-0240
Practice Address - Fax:909-993-0247
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist