Healthcare Provider Details

I. General information

NPI: 1083275887
Provider Name (Legal Business Name): MICHELLE SINGSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE GRACE BREDE

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR RM 1C600
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

257 WOODSTOCK CIR
VACAVILLE CA
95687-3389
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7130
  • Fax:
Mailing address:
  • Phone: 509-944-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: