Provider Demographics
NPI:1720451115
Name:MICHEL, RENDELL LEE
Entity type:Individual
Prefix:
First Name:RENDELL
Middle Name:LEE
Last Name:MICHEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-0849
Mailing Address - Country:US
Mailing Address - Phone:252-917-6289
Mailing Address - Fax:252-917-6290
Practice Address - Street 1:4600 E 10TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-0849
Practice Address - Country:US
Practice Address - Phone:252-917-6289
Practice Address - Fax:252-917-6290
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist