Provider Demographics
NPI:1215923404
Name:PUGH, MICHAEL DAVID (RPH, BCOP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DAVID
Last Name:PUGH
Suffix:
Gender:M
Credentials:RPH, BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 JONES RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9173
Mailing Address - Country:US
Mailing Address - Phone:740-775-3116
Mailing Address - Fax:
Practice Address - Street 1:4439 STATE ROUTE 159
Practice Address - Street 2:SUITE 260
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8207
Practice Address - Country:US
Practice Address - Phone:740-779-7990
Practice Address - Fax:774-779-7871
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-16937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist