Provider Demographics
NPI:1497878458
Name:ATIE, MICHELLE KAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAY
Last Name:ATIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WELCH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-2864
Mailing Address - Country:US
Mailing Address - Phone:248-787-8858
Mailing Address - Fax:248-859-2832
Practice Address - Street 1:1001 WELCH RD STE 101
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48390-2864
Practice Address - Country:US
Practice Address - Phone:248-859-2804
Practice Address - Fax:248-859-2832
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302032644OtherPHARMACIST LICENSE