Healthcare Provider Details

I. General information

NPI: 1891989901
Provider Name (Legal Business Name): MICHELLE LEE RAGER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LEE HORN PHARMD

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

V. Phone/Fax

Practice location:
  • Phone: 910-667-9000
  • Fax:
Mailing address:
  • Phone: 910-667-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18362
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number700113
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: