Healthcare Provider Details

I. General information

NPI: 1487659470
Provider Name (Legal Business Name): RONALD ALLEN MIHELIC PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON ROAD NE EMORY UNIVERSITY HOSPITAL DEPARTMENT OF PHARMACY
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

1812 MASON MILL ROAD
DECATUR GA
30033-3422
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-7425
  • Fax: 404-712-1991
Mailing address:
  • Phone: 404-712-7425
  • Fax: 404-712-1991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH020152
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: