Provider Demographics
NPI:1306152251
Name:MOAWAD, MICHELLE (RPH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MOAWAD
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 1:8990 DUKE BLVD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8943
Mailing Address - Country:US
Mailing Address - Phone:513-336-2000
Mailing Address - Fax:
Practice Address - Street 1:148 LEATHER LEAF LN
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-7727
Practice Address - Country:US
Practice Address - Phone:513-228-2155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-28
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-19729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist