Provider Demographics
NPI:1295029122
Name:HATHOOT, MICHELE JEANNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:JEANNE
Last Name:HATHOOT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 LAPORTE AVE
Mailing Address - Street 2:T1286
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-6914
Mailing Address - Country:US
Mailing Address - Phone:219-531-6628
Mailing Address - Fax:219-531-6628
Practice Address - Street 1:2420 LAPORTE AVE
Practice Address - Street 2:T1286
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6914
Practice Address - Country:US
Practice Address - Phone:219-531-6628
Practice Address - Fax:219-531-6628
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017262A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist