Provider Demographics
NPI:1558253625
Name:SHOUP, MICHAELA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:
Last Name:SHOUP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-1904
Mailing Address - Country:US
Mailing Address - Phone:731-926-8171
Mailing Address - Fax:662-471-0136
Practice Address - Street 1:935 WAYNE RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-1904
Practice Address - Country:US
Practice Address - Phone:731-926-8171
Practice Address - Fax:731-926-8143
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23044183500000X
MSE-100779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist