Provider Demographics
NPI:1164703187
Name:FLUCKE, MICHELLE R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:R
Last Name:FLUCKE
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 1:532 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2553
Mailing Address - Country:US
Mailing Address - Phone:502-434-3122
Mailing Address - Fax:502-434-3123
Practice Address - Street 1:532 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2553
Practice Address - Country:US
Practice Address - Phone:502-434-3122
Practice Address - Fax:502-434-3123
Is Sole Proprietor?:No
Enumeration Date:2011-09-03
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023389A183500000X
KY014732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist