Provider Demographics
NPI:1346587391
Name:LAVERE, MICHELLE ELAINE (RPH)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ELAINE
Last Name:LAVERE
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 1:4226 SW UTTERBACK ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6854
Mailing Address - Country:US
Mailing Address - Phone:772-708-3887
Mailing Address - Fax:
Practice Address - Street 1:4226 SW UTTERBACK ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6854
Practice Address - Country:US
Practice Address - Phone:772-708-3887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist