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General NPI Number Information
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NPI Number | 1104463918
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Entity Type | Individual
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Provider Name | MICHELLE LYLE RPH
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Gender | Female
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Dates
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Enumeration Date | 12/01/2019
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Last Update Date | 12/01/2019
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Provider Practice Location Address
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Address Line | 2001 N MICHIGAN ST
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City | PLYMOUTH
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State | IN
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Zip | 46563-1020
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Country | US
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Telephone | 574-936-1980
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Fax | 574-936-1983
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Provider Business Mailing Address
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Address Line | 69520 REDWOOD RD
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City | WALKERTON
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State | IN
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Zip | 46574-8811
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Country | US
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Telephone | 574-220-3882
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Fax | 574-936-1983
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26019408A
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License Number State | IN
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