Provider Demographics
NPI:1134479553
Name:MAGUIRE, MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MAGUIRE
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 1:772 N HIGH ST
Mailing Address - Street 2:205
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1456
Mailing Address - Country:US
Mailing Address - Phone:614-282-5526
Mailing Address - Fax:
Practice Address - Street 1:500 W 12TH AVE
Practice Address - Street 2:#100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1214
Practice Address - Country:US
Practice Address - Phone:614-688-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03331213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist