Provider Demographics
NPI:1134184419
Name:STOTZ, MICHELLE MARIE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:STOTZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7217 LANE RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9701
Mailing Address - Country:US
Mailing Address - Phone:585-742-8014
Mailing Address - Fax:
Practice Address - Street 1:WAL-MART PHARMACY 10-1813
Practice Address - Street 2:6788 ROUTE 31 EAST
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513
Practice Address - Country:US
Practice Address - Phone:315-331-5084
Practice Address - Fax:315-331-7434
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047634183500000X
PARP045492T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20-047634OtherNEW YORK STATE EDUCATION