Michael Micelli, RPH.
Individual provider Active NPI Pharmacist · Ayden, NC
NPI 1043682735 · NPPES record last updated Oct 21, 2015
Key facts
- NPI
- 1043682735
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 24333 (NC)
- Practice address
- 182 NC 102 East
Ayden, NC 28513 - Phone
- (252) 746-2699
- Fax
- (252) 746-3164
- NPI assigned
- Oct 21, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24333 | NC | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 24333 | NC | Yes |
Addresses
Primary practice location
182 NC 102 East
Ayden, NC 28513
Mailing address
182 NC 102 East
Ayden, NC 28513
Phone (252) 746-2699
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 24333 | Other | NC | STATE LICENSE NUMBER |
Other providers in Ayden, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.