Provider Demographics
NPI:1346369386
Name:KIRCHOFF, MICCHAEL GORDON (RPH)
Entity Type:Individual
Prefix:
First Name:MICCHAEL
Middle Name:GORDON
Last Name:KIRCHOFF
Suffix:
Gender:M
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:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-0243
Mailing Address - Country:US
Mailing Address - Phone:251-937-5511
Mailing Address - Fax:
Practice Address - Street 1:710 MCMEANS AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-3348
Practice Address - Country:US
Practice Address - Phone:251-937-1101
Practice Address - Fax:251-937-1102
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist