Provider Demographics
NPI:1821650292
Name:DARMOFAL, GARY ANTHONY
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ANTHONY
Last Name:DARMOFAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E LANSING RD
Mailing Address - Street 2:
Mailing Address - City:POTTERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48876-9799
Mailing Address - Country:US
Mailing Address - Phone:517-645-9800
Mailing Address - Fax:
Practice Address - Street 1:121 E LANSING RD
Practice Address - Street 2:
Practice Address - City:POTTERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48876-9799
Practice Address - Country:US
Practice Address - Phone:517-645-9800
Practice Address - Fax:517-645-0900
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist