Provider Demographics
NPI:1710219373
Name:STORM, MICHELLE K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:K
Last Name:STORM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 CARNEGIE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3588
Mailing Address - Country:US
Mailing Address - Phone:714-457-9298
Mailing Address - Fax:909-890-9783
Practice Address - Street 1:735 CARNEGIE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3588
Practice Address - Country:US
Practice Address - Phone:714-457-9298
Practice Address - Fax:909-890-9783
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13211183500000X
TX40001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist