Provider Demographics
NPI:1043207160
Name:PAGE, MICHELLE ANGELA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANGELA
Last Name:PAGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 W MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092-2913
Mailing Address - Country:US
Mailing Address - Phone:860-559-6418
Mailing Address - Fax:
Practice Address - Street 1:366 W MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WEST SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06092-2913
Practice Address - Country:US
Practice Address - Phone:860-559-6418
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT81871835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy