Provider Demographics
NPI:1265830384
Name:VERSTELLE, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:VERSTELLE
Suffix:
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 1:5027 15TH AVE NE
Mailing Address - Street 2:APT 201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4347
Mailing Address - Country:US
Mailing Address - Phone:509-599-0869
Mailing Address - Fax:
Practice Address - Street 1:5027 15TH AVE NE
Practice Address - Street 2:APT 201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4347
Practice Address - Country:US
Practice Address - Phone:509-599-0869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-06
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician