Provider Demographics
NPI:1053914358
Name:DEGNAN, MICHELLE (RPH)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:DEGNAN
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 1:14701 SHADOW LAKES DR E
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5041
Mailing Address - Country:US
Mailing Address - Phone:317-698-3899
Mailing Address - Fax:
Practice Address - Street 1:1421 S RANGELINE RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2933
Practice Address - Country:US
Practice Address - Phone:317-844-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist