Provider Demographics
NPI:1407151483
Name:KROENING, MICHELLE M (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:KROENING
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 1:525 E LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3833
Mailing Address - Country:US
Mailing Address - Phone:219-326-9536
Mailing Address - Fax:219-326-9650
Practice Address - Street 1:525 E LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3833
Practice Address - Country:US
Practice Address - Phone:219-326-9536
Practice Address - Fax:219-326-9650
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017394A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26017394AOtherINDIANA STATE LICENSE