Provider Demographics
NPI:1053603290
Name:KRIETEMEYER, MICHELLE Y (RPH)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:Y
Last Name:KRIETEMEYER
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 1:240 LINCOLN CT
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:44865-9409
Mailing Address - Country:US
Mailing Address - Phone:419-687-0032
Mailing Address - Fax:
Practice Address - Street 1:11 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1367
Practice Address - Country:US
Practice Address - Phone:419-347-1506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03122596OtherOHIO PHARMACIST IDENTIFICATION NUMBER