Provider Demographics
NPI:1881083244
Name:MICHAELS, ALLEN
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:
Last Name:MICHAELS
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 1:5375 RIVERFRONT DR APT B
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5230
Mailing Address - Country:US
Mailing Address - Phone:813-787-0254
Mailing Address - Fax:
Practice Address - Street 1:5375 RIVERFRONT DR APT B
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5230
Practice Address - Country:US
Practice Address - Phone:813-787-0254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI 29716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPSI 29716OtherDEPARTMENT OF HEALTH