Provider Demographics
NPI:1912596677
Name:POWERS, MICHELLE AILEEN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:AILEEN
Last Name:POWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1797 SENECA BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5619
Mailing Address - Country:US
Mailing Address - Phone:740-398-2808
Mailing Address - Fax:
Practice Address - Street 1:277 W SR 436
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-4228
Practice Address - Country:US
Practice Address - Phone:407-389-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60010183500000X
OH03-320187183500000X
FLPS6010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist