Healthcare Provider Details

I. General information

NPI: 1619086808
Provider Name (Legal Business Name): MICHELLE SUZANNE WILHARDT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD 119A
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

1124 W STATE AVE
PHOENIX AZ
85021-8071
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 602-861-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12006
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: