Provider Demographics
NPI:1639767866
Name:MCGAW, MICHELLE (RPH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCGAW
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 1:58 CAMARA DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-2909
Mailing Address - Country:US
Mailing Address - Phone:401-855-9344
Mailing Address - Fax:
Practice Address - Street 1:30 CENTRE OF NEW ENGLAND BLVD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6068
Practice Address - Country:US
Practice Address - Phone:401-827-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI3384183500000X
MA22700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist