MEDICARE: DR. MICHELLE K. STORM PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	13211	AZ
2	183500000X	Pharmacist	40001	TX

General Provider Information

NPI Number	:	1710219373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE K. STORM PHARM.D.

Provider Business Mailing Address
First Line	:	735 CARNEGIE DR
Second Line	:	SUITE 250
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3588
Country	:	US
Telephone Number	:	714-457-9298
Fax Number	:	909-890-9783

Provider Business Practice Location Address
First Line	:	735 CARNEGIE DR
Second Line	:	SUITE 250
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3588
Country	:	US
Telephone Number	:	714-457-9298
Fax Number	:	909-890-9783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2010
Last Update Date	:	08/21/2011

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