Provider Demographics
NPI:1528665478
Name:MICHELLES PHARMACY INC
Entity type:Organization
Organization Name:MICHELLES PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:217-854-4022
Mailing Address - Street 1:274 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1371
Mailing Address - Country:US
Mailing Address - Phone:217-854-4022
Mailing Address - Fax:
Practice Address - Street 1:274 N BROAD ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1371
Practice Address - Country:US
Practice Address - Phone:217-854-4022
Practice Address - Fax:217-854-4300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHELLES PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy