Provider Demographics
NPI:1609371533
Name:EDMONDS, MICHELLE SHAKE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:SHAKE
Last Name:EDMONDS
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 1:705 RIVER BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-1523
Mailing Address - Country:US
Mailing Address - Phone:260-570-3941
Mailing Address - Fax:
Practice Address - Street 1:570 ENON SPRINGS RD E
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4409
Practice Address - Country:US
Practice Address - Phone:615-355-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist