Provider Demographics
NPI:1932447091
Name:JAMES, MICHAEL ALLEN (CPHT, RPHT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:JAMES
Suffix:
Gender:M
Credentials:CPHT, RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N CHRISTMAS HILL RD
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2528
Mailing Address - Country:US
Mailing Address - Phone:321-529-4212
Mailing Address - Fax:
Practice Address - Street 1:375 N CHRISTMAS HILL RD
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2528
Practice Address - Country:US
Practice Address - Phone:321-529-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT0042183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRPT0442OtherSTATE LICENSE
240100102111258OtherPHARMACY TECHNICIAN CERTIFICATION BOARD