Provider Demographics
NPI:1912119868
Name:DUPREE, MICHAEL LAMAR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAMAR
Last Name:DUPREE
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 1:11800 HARDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-2480
Mailing Address - Country:US
Mailing Address - Phone:804-379-1303
Mailing Address - Fax:
Practice Address - Street 1:FCC PETERSBURG MEDIUM ATTN PHARMACY SVC
Practice Address - Street 2:1060 RIVER ROAD BOX 90042
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23804
Practice Address - Country:US
Practice Address - Phone:804-504-7200
Practice Address - Fax:804-504-7279
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017221183500000X
VA0202204204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist