Provider Demographics
NPI:1457957417
Name:CHAN, MICHELLE MEIZHONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MEIZHONG
Last Name:CHAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13697 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3923
Mailing Address - Country:US
Mailing Address - Phone:407-656-8333
Mailing Address - Fax:407-656-4133
Practice Address - Street 1:13697 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3923
Practice Address - Country:US
Practice Address - Phone:407-656-8333
Practice Address - Fax:407-656-4133
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist