Provider Demographics
NPI:1174695944
Name:ALLEN, MICHELLE EDWARDS (PHARMD, BCPS, FCCM,)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:EDWARDS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHARMD, BCPS, FCCM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 WEST ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3715
Mailing Address - Country:US
Mailing Address - Phone:707-819-6401
Mailing Address - Fax:
Practice Address - Street 1:SUTTER SANTA ROSA REGIONAL HOSPITAL DEPT. OF PHARMACY
Practice Address - Street 2:30 MARK WEST SPRINGS ROAD
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1436
Practice Address - Country:US
Practice Address - Phone:707-576-4340
Practice Address - Fax:707-541-9120
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558881835P1200X
AZ129741835P1200X
CA100531835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy