Provider Demographics
NPI:1053913905
Name:MIKHAIL, MATTHEW (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MIKHAIL
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 1:3477 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372-1014
Mailing Address - Country:US
Mailing Address - Phone:610-383-5461
Mailing Address - Fax:
Practice Address - Street 1:3477 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1014
Practice Address - Country:US
Practice Address - Phone:610-383-5461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist