Provider Demographics
NPI:1619642311
Name:CANTRELL, MICHAEL BLAKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BLAKE
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6570 FLAT FRK
Mailing Address - Street 2:
Mailing Address - City:SALYERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41465-7219
Mailing Address - Country:US
Mailing Address - Phone:937-571-4075
Mailing Address - Fax:
Practice Address - Street 1:476 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-2049
Practice Address - Country:US
Practice Address - Phone:606-743-3186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034384271835P0018X
KY020152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist