Provider Demographics
NPI:1366203945
Name:MINICH, HALEY MICHAEL
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:MICHAEL
Last Name:MINICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4276 N SHIRE LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2575
Mailing Address - Country:US
Mailing Address - Phone:814-319-5486
Mailing Address - Fax:
Practice Address - Street 1:1415 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2701
Practice Address - Country:US
Practice Address - Phone:216-325-5192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP458200183500000X
OH03443889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist