Provider Demographics
NPI:1396986014
Name:SKINNER, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SKINNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 TALBOTT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4334
Mailing Address - Country:US
Mailing Address - Phone:240-554-0310
Mailing Address - Fax:
Practice Address - Street 1:316 TALBOTT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4334
Practice Address - Country:US
Practice Address - Phone:240-554-0310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14563183500000X
VA0202208775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist