Provider Demographics
NPI:1326457003
Name:KIRBY, MICHELLE LYNN (RPH, CMF)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:KIRBY
Suffix:
Gender:F
Credentials:RPH, CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-2112
Mailing Address - Country:US
Mailing Address - Phone:828-464-1354
Mailing Address - Fax:828-464-7312
Practice Address - Street 1:126 1ST AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613
Practice Address - Country:US
Practice Address - Phone:828-464-1354
Practice Address - Fax:828-464-7312
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
561008788OtherNPI 1366588972
NC561008788OtherMEDICARE PTAN # 1112520001