Provider Demographics
NPI:1548603459
Name:DAMELIO, MICHAEL PATRIC (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRIC
Last Name:DAMELIO
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 1:1312 SNOWSHOE CT
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-8167
Mailing Address - Country:US
Mailing Address - Phone:727-871-3986
Mailing Address - Fax:
Practice Address - Street 1:777 GOLD HILL PL S
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-1101
Practice Address - Country:US
Practice Address - Phone:719-687-6007
Practice Address - Fax:719-687-9017
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA18702183500000X
FLPS43136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist