Provider Demographics
NPI:1063759769
Name:TRAGO, MICHELE KOLB (RPH)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:KOLB
Last Name:TRAGO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13900 NARCOOSSEE RD.
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-0000
Mailing Address - Country:US
Mailing Address - Phone:407-240-2107
Mailing Address - Fax:407-459-1254
Practice Address - Street 1:13900 NARCOOSSEE RD.
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-0000
Practice Address - Country:US
Practice Address - Phone:407-240-2107
Practice Address - Fax:407-459-1254
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist