Healthcare Provider Details

I. General information

NPI: 1528739109
Provider Name (Legal Business Name): MICHELLE LUCILLE HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25100 HARPER AVE
SAINT CLAIR SHORES MI
48081-2207
US

IV. Provider business mailing address

26808 ROSEWOOD ST
ROSEVILLE MI
48066-3438
US

V. Phone/Fax

Practice location:
  • Phone: 586-445-8181
  • Fax:
Mailing address:
  • Phone: 586-944-9707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303010400
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: