Provider Demographics
NPI:1962785048
Name:MYERS, MICHELLE DAWN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DAWN
Last Name:MYERS
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 1:1178 S OLD STATE ROAD 3
Mailing Address - Street 2:
Mailing Address - City:AVILLA
Mailing Address - State:IN
Mailing Address - Zip Code:46710-9650
Mailing Address - Country:US
Mailing Address - Phone:260-897-2562
Mailing Address - Fax:
Practice Address - Street 1:11932 LIMA RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-8658
Practice Address - Country:US
Practice Address - Phone:260-637-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020550A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist