Provider Demographics
NPI:1821391731
Name:KING, MICHELLE LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:KING
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 1:500 SUNCREST TOWN CENTRE DR
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1820
Mailing Address - Country:US
Mailing Address - Phone:304-285-6790
Mailing Address - Fax:
Practice Address - Street 1:500 SUNCREST TOWN CENTRE DR
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1820
Practice Address - Country:US
Practice Address - Phone:304-285-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007083183500000X
TN24232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist