Provider Demographics
NPI:1407485865
Name:KERESTES, MICHELLE
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:KERESTES
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 1:1331 W MOREHEAD ST APT 137
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5368
Mailing Address - Country:US
Mailing Address - Phone:704-576-6760
Mailing Address - Fax:
Practice Address - Street 1:1257 25TH STREET PL SE APT 2109
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-9658
Practice Address - Country:US
Practice Address - Phone:704-576-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist