Provider Demographics
NPI:1306441209
Name:JACQUES, MICHELLE YVONNE (RPH)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:YVONNE
Last Name:JACQUES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:YVONNE
Other - Last Name:CRANSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:4 SANDY CT
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1792
Mailing Address - Country:US
Mailing Address - Phone:401-279-1026
Mailing Address - Fax:
Practice Address - Street 1:970 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2800
Practice Address - Country:US
Practice Address - Phone:413-737-6346
Practice Address - Fax:413-785-5850
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty