Provider Demographics
NPI:1972321891
Name:MEALY, MICHELLE C (RPH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:MEALY
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 1:421 N PENNSYLVANIA ST APT 1208
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2439
Mailing Address - Country:US
Mailing Address - Phone:239-821-2118
Mailing Address - Fax:
Practice Address - Street 1:6010 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-2901
Practice Address - Country:US
Practice Address - Phone:317-783-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26153183500000X
MAPH21872183500000X
IN26030737A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist