Provider Demographics
NPI:1437472859
Name:CALLAHAN, MICHELLE P (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:P
Last Name:CALLAHAN
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 1:50 TOPPING DR
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3412
Mailing Address - Country:US
Mailing Address - Phone:631-369-9035
Mailing Address - Fax:
Practice Address - Street 1:53895 MAIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-4644
Practice Address - Country:US
Practice Address - Phone:631-765-3434
Practice Address - Fax:631-765-4395
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038754-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist