Provider Demographics
NPI:1699058727
Name:ROUSSEAU, MICHELLE ELAINE (RPH)
Entity type:Individual
Prefix:PROF
First Name:MICHELLE
Middle Name:ELAINE
Last Name:ROUSSEAU
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 1:160 EAST CENTRAL STREET
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038
Mailing Address - Country:US
Mailing Address - Phone:508-541-1436
Mailing Address - Fax:508-528-0687
Practice Address - Street 1:160 E CENTRAL ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-1400
Practice Address - Country:US
Practice Address - Phone:508-541-1436
Practice Address - Fax:508-528-0687
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist