Provider Demographics
NPI:1396025995
Name:MICHIENZI, ANGELA (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MICHIENZI
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 1:7774 PARK RIDGE DR SW
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9158
Mailing Address - Country:US
Mailing Address - Phone:616-662-1085
Mailing Address - Fax:
Practice Address - Street 1:7774 PARK RIDGE DR SW
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-9158
Practice Address - Country:US
Practice Address - Phone:616-662-1085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist