Provider Demographics
NPI:1275668139
Name:WEST, MICHAEL W (DPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:W
Last Name:WEST
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CEDAR BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-5032
Mailing Address - Country:US
Mailing Address - Phone:423-323-4081
Mailing Address - Fax:423-378-7320
Practice Address - Street 1:1880 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-5190
Practice Address - Country:US
Practice Address - Phone:423-378-7311
Practice Address - Fax:423-378-7320
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC002281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist