Provider Demographics
NPI:1104102532
Name:MEYER, MICHELLE ROSE (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROSE
Last Name:MEYER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 MARBLEVISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-9014
Mailing Address - Country:US
Mailing Address - Phone:614-566-9067
Mailing Address - Fax:614-566-8337
Practice Address - Street 1:111 S GRANT AVE
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4701
Practice Address - Country:US
Practice Address - Phone:614-566-9067
Practice Address - Fax:614-566-8337
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist