Provider Demographics
NPI:1235410416
Name:DUDICK, MICHAEL WALTER (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WALTER
Last Name:DUDICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17071 FORT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-6656
Mailing Address - Country:US
Mailing Address - Phone:734-281-2927
Mailing Address - Fax:734-281-4979
Practice Address - Street 1:17071 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-6656
Practice Address - Country:US
Practice Address - Phone:734-281-2927
Practice Address - Fax:734-281-4979
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI532024677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist