Provider Demographics
NPI:1447559133
Name:DEEL, MICHAEL BRIAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:DEEL
Suffix:
Gender:M
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:P.O. BOX 1798
Mailing Address - Street 2:603 CULPEPPER ROAD
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-1798
Mailing Address - Country:US
Mailing Address - Phone:276-328-6304
Mailing Address - Fax:
Practice Address - Street 1:1123 INDIAN CREEK ROAD
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:POUND
Practice Address - State:VA
Practice Address - Zip Code:24279-0610
Practice Address - Country:US
Practice Address - Phone:276-796-4751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist