Provider Demographics
NPI:1477158350
Name:KIRK, MICHELLE M
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:KIRK
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 1:5525 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2211
Mailing Address - Country:US
Mailing Address - Phone:513-398-7609
Mailing Address - Fax:513-398-9904
Practice Address - Street 1:5525 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2211
Practice Address - Country:US
Practice Address - Phone:513-398-7609
Practice Address - Fax:513-398-9904
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03324320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist