Provider Demographics
NPI:1912212051
Name:SHIRLEY, MICHELE LEIGH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEIGH
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633D MEDICAL GROUP HOSPITAL
Mailing Address - Street 2:77 NEALY AVENUE, BUILDING 257
Mailing Address - City:JOINT BASE LANGLEY-EUSTIS
Mailing Address - State:VA
Mailing Address - Zip Code:23665-3216
Mailing Address - Country:US
Mailing Address - Phone:757-225-2238
Mailing Address - Fax:757-225-1807
Practice Address - Street 1:633D MEDICAL GROUP HOSPITAL
Practice Address - Street 2:77 NEALY AVENUE, BUILDING 257
Practice Address - City:JOINT BASE LANGLEY-EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23665
Practice Address - Country:US
Practice Address - Phone:757-225-2238
Practice Address - Fax:757-225-1807
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist