Provider Demographics
NPI:1205181377
Name:CLINE, MICHELLE MOON
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MOON
Last Name:CLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 JONESTOWN RD STE 5
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4731
Mailing Address - Country:US
Mailing Address - Phone:336-774-1445
Mailing Address - Fax:336-774-1986
Practice Address - Street 1:300 JONESTOWN RD STE 5
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4731
Practice Address - Country:US
Practice Address - Phone:336-774-1445
Practice Address - Fax:336-774-1986
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist