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General NPI Number Information
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NPI Number | 1053616128
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Entity Type | Individual
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Provider Name | MICHAEL KUCKES RPH
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Gender | Male
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Dates
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Enumeration Date | 01/20/2011
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 405 W 8TH ST
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City | MONROE
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State | WI
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Zip | 53566-1063
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Country | US
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Telephone | 608-325-3310
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Fax |
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Provider Business Mailing Address
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Address Line | 5012 N RINK RD
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City | LENA
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State | IL
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Zip | 61048-9579
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Country | US
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Telephone | 815-238-6861
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051-037966
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License Number State | IL
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