Healthcare Provider Details

I. General information

NPI: 1669741484
Provider Name (Legal Business Name): MICHELLE J JAMES RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 W LAKE MARY BLVD
LAKE MARY FL
32746-3349
US

IV. Provider business mailing address

4024 W LAKE MARY BLVD
LAKE MARY FL
32746-3349
US

V. Phone/Fax

Practice location:
  • Phone: 407-549-3115
  • Fax: 407-333-5248
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS31994
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: