Provider Demographics
NPI:1154096717
Name:MCKAY, MICHELLE RAE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RAE
Last Name:MCKAY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 19TH AVE N # 168
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-5906
Mailing Address - Country:US
Mailing Address - Phone:701-238-6794
Mailing Address - Fax:
Practice Address - Street 1:1100 19TH AVE N # 168
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-5906
Practice Address - Country:US
Practice Address - Phone:701-238-6794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNRPH121212183500000X
SD6126183500000X
NDRPH5466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist