Provider Demographics
NPI:1750537148
Name:WARREN, MICHAEL L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:WARREN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 FASER HALL
Mailing Address - Street 2:SCHOOL OF PHARMACY
Mailing Address - City:UNIVERSITY
Mailing Address - State:MS
Mailing Address - Zip Code:38677
Mailing Address - Country:US
Mailing Address - Phone:662-915-6754
Mailing Address - Fax:
Practice Address - Street 1:REBEL DRIVE
Practice Address - Street 2:VB HARRISON HEALTH CLINIC, STUDENT HEALTH PHARMACY
Practice Address - City:UNIVERSITY
Practice Address - State:MS
Practice Address - Zip Code:38677
Practice Address - Country:US
Practice Address - Phone:662-915-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist