Provider Demographics
NPI:1962141556
Name:MICLAT, JOHN RANIER DE LOS REYES (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHN RANIER
Middle Name:DE LOS REYES
Last Name:MICLAT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 MONTROSE BLVD APT 441
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4379
Mailing Address - Country:US
Mailing Address - Phone:281-543-2761
Mailing Address - Fax:
Practice Address - Street 1:300 MILAM ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-1860
Practice Address - Country:US
Practice Address - Phone:713-223-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist