Provider Demographics
NPI:1568766426
Name:SHORE, MICHELE CARNEVALE (BS)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:CARNEVALE
Last Name:SHORE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:CARNEVALE
Other - Last Name:SHORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:2147 BLOWING ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6155
Mailing Address - Country:US
Mailing Address - Phone:828-262-0900
Mailing Address - Fax:828-262-5107
Practice Address - Street 1:2147 BLOWING ROCK RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6155
Practice Address - Country:US
Practice Address - Phone:828-262-0900
Practice Address - Fax:828-262-5107
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist