Provider Demographics
NPI:1225800634
Name:DUTTRY, MICHAELA ROSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ROSE
Last Name:DUTTRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 GAMELAND RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16262-5007
Mailing Address - Country:US
Mailing Address - Phone:724-664-1259
Mailing Address - Fax:
Practice Address - Street 1:105 GAMMA DR STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2991
Practice Address - Country:US
Practice Address - Phone:866-824-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist