Provider Demographics
NPI:1558916353
Name:FLINN, MICHAEL LESTER
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LESTER
Last Name:FLINN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 S COUNTY ROAD 180 E
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-7207
Mailing Address - Country:US
Mailing Address - Phone:812-593-0522
Mailing Address - Fax:
Practice Address - Street 1:200 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-2160
Practice Address - Country:US
Practice Address - Phone:317-398-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018251A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist