Provider Demographics
NPI:1962093518
Name:MALATLIAN, MICHELLE LYNNE (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNNE
Last Name:MALATLIAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 FRAGOMENI LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2164
Mailing Address - Country:US
Mailing Address - Phone:941-917-8448
Mailing Address - Fax:941-917-3607
Practice Address - Street 1:1700 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3555
Practice Address - Country:US
Practice Address - Phone:941-917-8448
Practice Address - Fax:941-917-3607
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS314131835C0205X
FL31413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835C0205XPharmacy Service ProvidersPharmacistCritical Care