Healthcare Provider Details

I. General information

NPI: 1104110055
Provider Name (Legal Business Name): MICHAEL S BRIGGS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39440 10TH ST W
PALMDALE CA
93551-3747
US

IV. Provider business mailing address

39440 10TH ST W
PALMDALE CA
93551-3747
US

V. Phone/Fax

Practice location:
  • Phone: 661-265-7361
  • Fax:
Mailing address:
  • Phone: 661-265-7361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number53476
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number291108-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: