Healthcare Provider Details

I. General information

NPI: 1518614130
Provider Name (Legal Business Name): CHRISTOPHER J MICHAUD PHARMD, BCCCP, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4512 BRETON RD SE
KENTWOOD MI
49508-5271
US

IV. Provider business mailing address

8745 GLEN NEVIS RD NE
ADA MI
49301-9756
US

V. Phone/Fax

Practice location:
  • Phone: 616-327-7800
  • Fax:
Mailing address:
  • Phone: 616-443-8539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302038697
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number5302038697
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: