Provider Demographics
NPI:1982036349
Name:MAUPIN, DALE B (RPH)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:B
Last Name:MAUPIN
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 1:10587 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HONOR
Mailing Address - State:MI
Mailing Address - Zip Code:49640-9761
Mailing Address - Country:US
Mailing Address - Phone:231-325-2735
Mailing Address - Fax:231-325-2737
Practice Address - Street 1:10587 MAIN ST
Practice Address - Street 2:
Practice Address - City:HONOR
Practice Address - State:MI
Practice Address - Zip Code:49640-9761
Practice Address - Country:US
Practice Address - Phone:231-325-2735
Practice Address - Fax:231-325-2737
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI532025423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist