Provider Demographics
NPI:1427650878
Name:O'ROURKE, MICHAEL (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 NW LAKE VALLEY TER
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-8644
Mailing Address - Country:US
Mailing Address - Phone:727-686-6691
Mailing Address - Fax:
Practice Address - Street 1:2767 W US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4755
Practice Address - Country:US
Practice Address - Phone:386-755-0463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist