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General NPI Number Information
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NPI Number | 1275803132
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Entity Type | Individual
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Provider Name | MICHAEL JAMES MICHUTKA PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 1521 GULL RD PHARMACY DEPARTMENT
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City | KALAMAZOO
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State | MI
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Zip | 49048-1640
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Country | US
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Telephone | 262-226-5206
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Fax |
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Provider Business Mailing Address
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Address Line | 4355 KETTLE MORAINE DR APT 3A
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City | KALAMAZOO
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State | MI
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Zip | 49048-3145
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Country | US
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Telephone | 269-226-5206
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 5302036094
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License Number State | MI
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