Provider Demographics
NPI:1871888420
Name:MICHAUD, ZACHARY A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:A
Last Name:MICHAUD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21500 NE HALSEY ST
Mailing Address - Street 2:T1406
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-8616
Mailing Address - Country:US
Mailing Address - Phone:503-491-8953
Mailing Address - Fax:503-491-8953
Practice Address - Street 1:21500 NE HALSEY ST
Practice Address - Street 2:T1406
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024-8616
Practice Address - Country:US
Practice Address - Phone:503-491-8953
Practice Address - Fax:503-491-8953
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist