Provider Demographics
NPI:1396137725
Name:SCUDDER, MICHELE L (RPH)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:SCUDDER
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 1:221 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:IN
Mailing Address - Zip Code:47042-9523
Mailing Address - Country:US
Mailing Address - Phone:812-689-5553
Mailing Address - Fax:812-689-6701
Practice Address - Street 1:221 S HIGH ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:IN
Practice Address - Zip Code:47042-9523
Practice Address - Country:US
Practice Address - Phone:812-689-5553
Practice Address - Fax:812-689-6701
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03225308183500000X
IN26020942A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist