Provider Demographics
NPI:1659976272
Name:MICHAEL, AMBER RAE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:RAE
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:RAE
Other - Last Name:HICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1446 WIMBLEDON CIR
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2450
Mailing Address - Country:US
Mailing Address - Phone:330-715-4219
Mailing Address - Fax:
Practice Address - Street 1:9302 OLDE 8 RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-2027
Practice Address - Country:US
Practice Address - Phone:330-468-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03323916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist