Provider Demographics
NPI:1073117818
Name:MICHAEL, ABRAHAM W (RPH)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:W
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 N DRUID HILLS RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3926
Mailing Address - Country:US
Mailing Address - Phone:404-679-4666
Mailing Address - Fax:404-679-5394
Practice Address - Street 1:2830 N DRUID HILLS RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3926
Practice Address - Country:US
Practice Address - Phone:404-679-4666
Practice Address - Fax:404-679-5394
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18179183500000X
GARPH023885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist