Provider Demographics
NPI:1467948216
Name:MICHELS, JOELLE
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:MICHELS
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 1:461 GENERAL DR
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-1863
Mailing Address - Country:US
Mailing Address - Phone:859-344-8045
Mailing Address - Fax:
Practice Address - Street 1:3712 WINSTON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-1469
Practice Address - Country:US
Practice Address - Phone:859-261-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist