Provider Demographics
NPI:1467751065
Name:MICHAEL, PATRICIA LYNNE (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNNE
Last Name:MICHAEL
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 1:18479 EDERER RD
Mailing Address - Street 2:
Mailing Address - City:HEMLOCK
Mailing Address - State:MI
Mailing Address - Zip Code:48626-9775
Mailing Address - Country:US
Mailing Address - Phone:989-642-4871
Mailing Address - Fax:
Practice Address - Street 1:4598 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3803
Practice Address - Country:US
Practice Address - Phone:989-792-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist