Healthcare Provider Details

I. General information

NPI: 1790309201
Provider Name (Legal Business Name): MICHELLE DIAN DEMALINE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 WINDER HWY
FLOWERY BRANCH GA
30542-3022
US

IV. Provider business mailing address

PO BOX 1033
BUFORD GA
30515-1033
US

V. Phone/Fax

Practice location:
  • Phone: 770-539-5030
  • Fax:
Mailing address:
  • Phone: 770-510-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH020918
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: