Provider Demographics
NPI:1710480686
Name:DUTEAU, MICHAEL D (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:DUTEAU
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 1:6333 STATE ROUTE 298
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1554
Mailing Address - Country:US
Mailing Address - Phone:315-451-2873
Mailing Address - Fax:
Practice Address - Street 1:6333 STATE ROUTE 298
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-1554
Practice Address - Country:US
Practice Address - Phone:315-451-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist