Provider Demographics
NPI:1790202406
Name:KAGUYUTAN, MICHELE NOREEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:NOREEN
Last Name:KAGUYUTAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 DELANCEY WAY
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-8519
Mailing Address - Country:US
Mailing Address - Phone:856-265-4153
Mailing Address - Fax:
Practice Address - Street 1:953 ROUTE 33
Practice Address - Street 2:
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-2707
Practice Address - Country:US
Practice Address - Phone:609-890-2846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02949500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist