Provider Demographics
NPI:1720238975
Name:PRESTON, MICHELLE J (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:PRESTON
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 1:600 TECHNOLOGY PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-4126
Mailing Address - Country:US
Mailing Address - Phone:888-637-4276
Mailing Address - Fax:866-587-4276
Practice Address - Street 1:600 TECHNOLOGY PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-4126
Practice Address - Country:US
Practice Address - Phone:888-637-4276
Practice Address - Fax:866-587-4276
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15170-040183500000X
MAPH233958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist