Provider Demographics
NPI:1376831156
Name:PHILLIPS, MICHELLE LYNN (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 GESSNER RD
Mailing Address - Street 2:TARGET PHGARMACY
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2505
Mailing Address - Country:US
Mailing Address - Phone:713-300-0228
Mailing Address - Fax:713-300-0228
Practice Address - Street 1:984 GESSNER RD
Practice Address - Street 2:7803 CHINON CIRCLE
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2505
Practice Address - Country:US
Practice Address - Phone:713-300-0228
Practice Address - Fax:713-300-0228
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183500000XOther#18 PHARMACY SERVICE PROVIDERS