Provider Demographics
NPI:1194979716
Name:REILLY, MICHELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:BOWCUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11605 W SARATOGA PL
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-1920
Mailing Address - Country:US
Mailing Address - Phone:303-549-1664
Mailing Address - Fax:
Practice Address - Street 1:11605 W SARATOGA PL
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-1920
Practice Address - Country:US
Practice Address - Phone:303-549-1664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0011350183500000X
CO18974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist