Provider Demographics
NPI:1184994246
Name:MCINTOSH, MICHELLE (RPH)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:MCINTOSH
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 1:4582 E HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-9724
Mailing Address - Country:US
Mailing Address - Phone:850-678-8929
Mailing Address - Fax:850-897-9506
Practice Address - Street 1:4582 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9724
Practice Address - Country:US
Practice Address - Phone:850-678-8929
Practice Address - Fax:850-897-9506
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31302183500000X
TX34506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist