Provider Demographics
NPI:1790002582
Name:TUOHY, MICHELLE DUANA (RPH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DUANA
Last Name:TUOHY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:DUANA
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1323 BIA ROUTE 4
Mailing Address - Street 2:PO BOX 200
Mailing Address - City:FORT THOMPSON
Mailing Address - State:SD
Mailing Address - Zip Code:57339-0200
Mailing Address - Country:US
Mailing Address - Phone:605-245-2285
Mailing Address - Fax:605-245-2384
Practice Address - Street 1:1323 BIA ROUTE 4
Practice Address - Street 2:
Practice Address - City:FORT THOMPSON
Practice Address - State:SD
Practice Address - Zip Code:57339-0200
Practice Address - Country:US
Practice Address - Phone:605-245-2285
Practice Address - Fax:605-245-2384
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR5370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5549010Medicaid