Provider Demographics
NPI:1952155632
Name:WEBER, MICHELLE A (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:WEBER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 ASH ST
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1254
Mailing Address - Country:US
Mailing Address - Phone:308-430-2443
Mailing Address - Fax:
Practice Address - Street 1:2250 N DIERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1258
Practice Address - Country:US
Practice Address - Phone:308-381-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist