Provider Demographics
NPI:1366109456
Name:MEYER, MICHELLE LYNNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNNE
Last Name:MEYER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:LYNNE
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 GREENWICH ST # 312A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2703
Mailing Address - Country:US
Mailing Address - Phone:914-774-5859
Mailing Address - Fax:
Practice Address - Street 1:850 3RD AVE STE 404
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-1523
Practice Address - Country:US
Practice Address - Phone:855-687-8369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist