Provider Demographics
NPI:1255764460
Name:DUFFIN, MICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DUFFIN
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 1:146 BILLOWS DR.
Mailing Address - Street 2:
Mailing Address - City:MT. ROYAL
Mailing Address - State:NJ
Mailing Address - Zip Code:08061
Mailing Address - Country:US
Mailing Address - Phone:484-716-4649
Mailing Address - Fax:
Practice Address - Street 1:146 BILLOWS DR.
Practice Address - Street 2:
Practice Address - City:MOUNT ROYAL
Practice Address - State:NJ
Practice Address - Zip Code:08061
Practice Address - Country:US
Practice Address - Phone:484-716-4649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP940440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4847164649Medicaid
PA4847164649Medicaid
PA4847164649Medicare NSC
PA4847164649Medicare PIN