Provider Demographics
NPI:1619141314
Name:MICHAEL, PHILIP ERNEST II (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ERNEST
Last Name:MICHAEL
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1570
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-1570
Mailing Address - Country:US
Mailing Address - Phone:304-855-4541
Mailing Address - Fax:304-855-4355
Practice Address - Street 1:3602 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-1570
Practice Address - Country:US
Practice Address - Phone:304-855-4541
Practice Address - Fax:304-855-4355
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist