Healthcare Provider Details

I. General information

NPI: 1982999892
Provider Name (Legal Business Name): LANCE MICHAEL MYKITA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5837 SUNRISE BLVD
CITRUS HEIGHTS CA
95610-6866
US

IV. Provider business mailing address

1584 MANASCO CIR
FOLSOM CA
95630-7348
US

V. Phone/Fax

Practice location:
  • Phone: 916-526-0302
  • Fax:
Mailing address:
  • Phone: 916-984-6609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: