Provider Demographics
NPI:1003173709
Name:HATCHETT, MICHELLE MALLERY
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MALLERY
Last Name:HATCHETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MALLERY
Other - Last Name:MONSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5040 FILAREES CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-1321
Mailing Address - Country:US
Mailing Address - Phone:303-868-7363
Mailing Address - Fax:
Practice Address - Street 1:1915 NE TERRE VIEW DR APT 59D
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-4544
Practice Address - Country:US
Practice Address - Phone:303-868-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR 60221618183500000X
COPHA.0020862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist