Provider Demographics
NPI:1720451115
Name:MICHEL, RENDELL
Entity Type:Individual
Prefix:
First Name:RENDELL
Middle Name:
Last Name:MICHEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 US HIGHWAY 13 S
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-9481
Mailing Address - Country:US
Mailing Address - Phone:252-332-3545
Mailing Address - Fax:252-332-2753
Practice Address - Street 1:2150 US HIGHWAY 13 S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-9481
Practice Address - Country:US
Practice Address - Phone:252-332-3545
Practice Address - Fax:252-332-2753
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist