Provider Demographics
NPI:1598369902
Name:WIDHOLM, MICHELLE NANCY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:NANCY
Last Name:WIDHOLM
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 1:2400 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7846
Mailing Address - Country:US
Mailing Address - Phone:804-643-1383
Mailing Address - Fax:
Practice Address - Street 1:2400 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7846
Practice Address - Country:US
Practice Address - Phone:804-643-1383
Practice Address - Fax:804-643-1388
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022150033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy