Provider Demographics
NPI:1659628477
Name:NOTHDURFT, MICHAEL LEE (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:NOTHDURFT
Suffix:
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 1:2880 N CENTRE CT
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1203
Mailing Address - Country:US
Mailing Address - Phone:928-772-4938
Mailing Address - Fax:928-772-4956
Practice Address - Street 1:2880 N CENTRE CT
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1203
Practice Address - Country:US
Practice Address - Phone:928-772-4938
Practice Address - Fax:928-772-4956
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist