Provider Demographics
NPI:1265713481
Name:LOOS, MICHELLE S (BS)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:S
Last Name:LOOS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2646
Mailing Address - Country:US
Mailing Address - Phone:859-331-0370
Mailing Address - Fax:
Practice Address - Street 1:1825 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-2646
Practice Address - Country:US
Practice Address - Phone:859-331-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist