MEDICARE: MRS. MICHELLE CHILDERS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS34866	FL
2	183500000X	Pharmacist	013536	KY
3	183500000X	Pharmacist	0000029346	TN

General Provider Information

NPI Number	:	1285948349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE CHILDERS RPH

Provider Business Mailing Address
First Line	:	503 SUNPORT LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7874
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 SUNPORT LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7874
Country	:	US
Telephone Number	:	407-513-6474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2010
Last Update Date	:	08/01/2010

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