Provider Demographics
NPI:1215502083
Name:DUFORT, ANN-MARIE (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:
Last Name:DUFORT
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6614
Mailing Address - Country:US
Mailing Address - Phone:989-631-4321
Mailing Address - Fax:
Practice Address - Street 1:2 DENNIS CT
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-3436
Practice Address - Country:US
Practice Address - Phone:198-994-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303012617183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician