Provider Demographics
NPI:1174825939
Name:DEWEY, MICHEAL A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:A
Last Name:DEWEY
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 1:11895 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1065
Mailing Address - Country:US
Mailing Address - Phone:804-360-3268
Mailing Address - Fax:
Practice Address - Street 1:11895 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1065
Practice Address - Country:US
Practice Address - Phone:804-360-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist