Provider Demographics
NPI:1437497765
Name:O'NEILL, MICHELLE JEAN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JEAN
Last Name:O'NEILL
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 1:3970 VALLEY GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-6773
Mailing Address - Country:US
Mailing Address - Phone:540-977-6481
Mailing Address - Fax:540-977-6483
Practice Address - Street 1:3970 VALLEY GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-6773
Practice Address - Country:US
Practice Address - Phone:540-977-6481
Practice Address - Fax:540-977-6483
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist