Provider Demographics
NPI:1386864627
Name:SORG, MICHAEL T (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:SORG
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 1:1529 E 1200 S
Mailing Address - Street 2:
Mailing Address - City:HAUBSTADT
Mailing Address - State:IN
Mailing Address - Zip Code:47639-7932
Mailing Address - Country:US
Mailing Address - Phone:812-453-7478
Mailing Address - Fax:
Practice Address - Street 1:4828 DAVIS LANT DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8919
Practice Address - Country:US
Practice Address - Phone:812-475-9541
Practice Address - Fax:812-475-9636
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017706A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist