Provider Demographics
NPI:1730158205
Name:MCDUFFEE, MICHAEL KENNETH (DPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KENNETH
Last Name:MCDUFFEE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 NASHVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3102
Mailing Address - Country:US
Mailing Address - Phone:615-265-0521
Mailing Address - Fax:615-265-0522
Practice Address - Street 1:420 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3120
Practice Address - Country:US
Practice Address - Phone:615-451-2455
Practice Address - Fax:615-451-4284
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC6549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist