Provider Demographics
NPI:1710292776
Name:ELMORE, MICHAEL W (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:ELMORE
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 1:2069 21ST ST SE
Mailing Address - Street 2:APT X
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-3586
Mailing Address - Country:US
Mailing Address - Phone:704-807-6970
Mailing Address - Fax:
Practice Address - Street 1:2427 SPRINGS RD NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3069
Practice Address - Country:US
Practice Address - Phone:828-256-2435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-15
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17199183500000X
TN23988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist