Provider Demographics
NPI:1629167184
Name:COUTO, MARCELO M (BPHARM, RPH)
Entity Type:Individual
Prefix:MR
First Name:MARCELO
Middle Name:M
Last Name:COUTO
Suffix:
Gender:M
Credentials:BPHARM, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4582 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:POTTERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48876-8610
Mailing Address - Country:US
Mailing Address - Phone:517-645-2429
Mailing Address - Fax:
Practice Address - Street 1:921 W HOLMES RD
Practice Address - Street 2:PHARMACY DEPT.
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0439
Practice Address - Country:US
Practice Address - Phone:517-393-7009
Practice Address - Fax:517-393-0635
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist