Healthcare Provider Details

I. General information

NPI: 1487856332
Provider Name (Legal Business Name): MICHELLE THERESE AGUIGUI SANNICOLAS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE SAN NICOLAS DELOSO PHARMD

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#162 AS APMAN DRIVE INARAJAN COMMUNITY HEALTH CENTER
INARAJAN GU
96929
US

IV. Provider business mailing address

128 ATIS CT
SANTA RITA GU
96915-1512
US

V. Phone/Fax

Practice location:
  • Phone: 671-828-7501
  • Fax: 671-828-7504
Mailing address:
  • Phone: 671-565-5191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH092
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: