Provider Demographics
NPI:1376313338
Name:CROSS, MICHELLE ANTOINETTE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANTOINETTE
Last Name:CROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 SUMMERS RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17061-8892
Mailing Address - Country:US
Mailing Address - Phone:717-649-2429
Mailing Address - Fax:
Practice Address - Street 1:1100 N 4TH ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-1238
Practice Address - Country:US
Practice Address - Phone:570-286-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035502L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist