Provider Demographics
NPI:1255752887
Name:MESSAMORE, MICHAEL MILLER
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MILLER
Last Name:MESSAMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CAIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617
Mailing Address - Country:US
Mailing Address - Phone:423-279-0841
Mailing Address - Fax:
Practice Address - Street 1:205 CAIN DR
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-4824
Practice Address - Country:US
Practice Address - Phone:423-279-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist