Provider Demographics
NPI:1013252030
Name:MARCOUX, MICHAEL DONALD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DONALD
Last Name:MARCOUX
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 PERU ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-3537
Mailing Address - Country:US
Mailing Address - Phone:518-578-0230
Mailing Address - Fax:
Practice Address - Street 1:5412 PERU ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-3537
Practice Address - Country:US
Practice Address - Phone:518-578-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist