Provider Demographics
NPI:1851588008
Name:GIGLI, MICHELE MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:GIGLI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-1402
Mailing Address - Country:US
Mailing Address - Phone:260-425-3696
Mailing Address - Fax:260-425-3073
Practice Address - Street 1:700 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1402
Practice Address - Country:US
Practice Address - Phone:260-425-3696
Practice Address - Fax:260-425-3073
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist