Healthcare Provider Details

I. General information

NPI: 1912119868
Provider Name (Legal Business Name): MICHAEL LAMAR DUPREE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FCC PETERSBURG MEDIUM ATTN PHARMACY SVC 1060 RIVER ROAD BOX 90042
PETERSBURG VA
23804
US

IV. Provider business mailing address

11800 HARDWOOD DR
MIDLOTHIAN VA
23114-2480
US

V. Phone/Fax

Practice location:
  • Phone: 804-504-7200
  • Fax: 804-504-7279
Mailing address:
  • Phone: 804-379-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH017221
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202204204
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: