Provider Demographics
NPI:1497635825
Name:STOBART, MICHELLE RENEE (PHAMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:STOBART
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10959 ECHO TRL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9079
Mailing Address - Country:US
Mailing Address - Phone:404-388-8704
Mailing Address - Fax:
Practice Address - Street 1:5580 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-3710
Practice Address - Country:US
Practice Address - Phone:317-297-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26031494A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist