Healthcare Provider Details

I. General information

NPI: 1639772379
Provider Name (Legal Business Name): MICHELLE DANISON PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5609 W SAGINAW HWY
LANSING MI
48917-2456
US

IV. Provider business mailing address

5351 SOMERSET DR
HOLT MI
48842-9516
US

V. Phone/Fax

Practice location:
  • Phone: 517-327-0620
  • Fax:
Mailing address:
  • Phone: 513-652-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03328689
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302412491
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: