Provider Demographics
NPI:1427442722
Name:FLYNN, MICHELLE (RPH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:FLYNN
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 1:150 TRI COUNTY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3217
Mailing Address - Country:US
Mailing Address - Phone:513-782-8405
Mailing Address - Fax:
Practice Address - Street 1:1700 DECLARATION DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-8441
Practice Address - Country:US
Practice Address - Phone:859-898-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist