Provider Demographics
NPI:1851949002
Name:NORTHRUP, MICHELE LEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LEE
Last Name:NORTHRUP
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 1:8235 PIPING ROCK ST
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523
Mailing Address - Country:US
Mailing Address - Phone:281-380-6577
Mailing Address - Fax:
Practice Address - Street 1:108 N MAIN
Practice Address - Street 2:STE B
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535
Practice Address - Country:US
Practice Address - Phone:936-681-8335
Practice Address - Fax:936-281-8320
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist