Provider Demographics
NPI:1194216572
Name:ORR, MICHAEL R SR
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:ORR
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9318 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3506
Mailing Address - Country:US
Mailing Address - Phone:313-996-5555
Mailing Address - Fax:313-429-5555
Practice Address - Street 1:9318 CONANT ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3506
Practice Address - Country:US
Practice Address - Phone:313-996-5555
Practice Address - Fax:313-429-5555
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist