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General NPI Number Information
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NPI Number | 1760749410
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Entity Type | Individual
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Provider Name | MICKY HA R.PH.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 2855 SMITH AVE
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City | BALTIMORE
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State | MD
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Zip | 21209-1426
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Country | US
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Telephone | 410-484-3200
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Fax | 410-484-1882
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Provider Business Mailing Address
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Address Line | 2633 LITER DR
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-1732
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Country | US
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Telephone | 443-574-4263
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Fax | 253-276-9686
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 20291
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 056550
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License Number State | NY
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