Provider Demographics
NPI:1689347841
Name:OSALA, MICHELLE ANGELICA BALL (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANGELICA BALL
Last Name:OSALA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANGELICA
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:429 GREEN SPRINGS HWY
Mailing Address - Street 2:SUITE 161 PMB 467
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:479-414-1672
Mailing Address - Fax:
Practice Address - Street 1:1151 18TH AVE S APT 2
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-6550
Practice Address - Country:US
Practice Address - Phone:479-414-1672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist