Provider Demographics
NPI:1952903676
Name:WEST, MICHAEL LEROY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEROY
Last Name:WEST
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 1:1920 E MARKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-6236
Mailing Address - Country:US
Mailing Address - Phone:765-456-3641
Mailing Address - Fax:765-457-3467
Practice Address - Street 1:1920 E MARKLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6236
Practice Address - Country:US
Practice Address - Phone:765-456-3641
Practice Address - Fax:765-457-3467
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026472A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist