Provider Demographics
NPI:1275582926
Name:DMITRUCHINA, RICHARD M (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:DMITRUCHINA
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 1:101 ROEHRIG ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1225
Mailing Address - Country:US
Mailing Address - Phone:313-510-7177
Mailing Address - Fax:
Practice Address - Street 1:2801 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2901
Practice Address - Country:US
Practice Address - Phone:734-676-3784
Practice Address - Fax:734-676-3793
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist