Provider Demographics
NPI:1497488142
Name:MERSHON, MICHAELA (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:MERSHON
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 1:7919 N COUNTY ROAD 75 E
Mailing Address - Street 2:
Mailing Address - City:LIZTON
Mailing Address - State:IN
Mailing Address - Zip Code:46149-9316
Mailing Address - Country:US
Mailing Address - Phone:317-213-6111
Mailing Address - Fax:
Practice Address - Street 1:10841 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7981
Practice Address - Country:US
Practice Address - Phone:317-273-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029747A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist