Provider Demographics
NPI:1740732643
Name:CHURCH, MICHELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:CHURCH
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 1:4874 W 6200 S
Mailing Address - Street 2:PHARMACY
Mailing Address - City:KEARNS
Mailing Address - State:UT
Mailing Address - Zip Code:84118-6701
Mailing Address - Country:US
Mailing Address - Phone:801-963-7200
Mailing Address - Fax:
Practice Address - Street 1:4874 W 6200 S
Practice Address - Street 2:PHARMACY
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-6701
Practice Address - Country:US
Practice Address - Phone:801-963-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5214841-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist