Provider Demographics
NPI:1164601639
Name:GRAZIANI, MICHELE LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LEE
Last Name:GRAZIANI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LEE
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1350 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8945
Mailing Address - Country:US
Mailing Address - Phone:321-254-5507
Mailing Address - Fax:321-254-5037
Practice Address - Street 1:1350 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8945
Practice Address - Country:US
Practice Address - Phone:321-254-5507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42312183500000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacist