Provider Demographics
NPI:1104106822
Name:LITTLE, MICHAEL R (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:LITTLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 BEECHMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4114
Mailing Address - Country:US
Mailing Address - Phone:513-231-8714
Mailing Address - Fax:513-231-9257
Practice Address - Street 1:7135 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4114
Practice Address - Country:US
Practice Address - Phone:513-231-8714
Practice Address - Fax:513-231-9257
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03314262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist