Provider Demographics
NPI:1477967305
Name:MICHEL, BRETT (RPH)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:MICHEL
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 1:2241 ROCKFORD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5262
Mailing Address - Country:US
Mailing Address - Phone:336-786-5166
Mailing Address - Fax:336-786-1445
Practice Address - Street 1:2241 ROCKFORD ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5262
Practice Address - Country:US
Practice Address - Phone:336-786-5166
Practice Address - Fax:336-786-1445
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17523183500000X
NY37865183500000X
FLPS47307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist