Provider Demographics
NPI:1942533203
Name:DEAN, GUY (R PH)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:
Last Name:DEAN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 S M 76
Mailing Address - Street 2:P.O. BOX 249
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9343
Mailing Address - Country:US
Mailing Address - Phone:989-345-5610
Mailing Address - Fax:989-345-7987
Practice Address - Street 1:2206 S M 76
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9343
Practice Address - Country:US
Practice Address - Phone:989-345-5610
Practice Address - Fax:989-345-7987
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist