Provider Demographics
NPI:1730376013
Name:MICHAELS, MICHELE RAE (RPH)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:RAE
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 E AUDUBON BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8499
Mailing Address - Country:US
Mailing Address - Phone:614-837-3455
Mailing Address - Fax:614-837-5506
Practice Address - Street 1:410 W 10TH AVE
Practice Address - Street 2:RHODES HALL RM 368
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-8179
Practice Address - Fax:614-293-8530
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-16926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist