Provider Demographics
NPI:1962974832
Name:KANUPP, MICHAEL AARON (PHARMD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:AARON
Last Name:KANUPP
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:SKYLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28776-0654
Mailing Address - Country:US
Mailing Address - Phone:828-776-0679
Mailing Address - Fax:
Practice Address - Street 1:128 CROSS ROAD DR
Practice Address - Street 2:
Practice Address - City:MILLS RIVER
Practice Address - State:NC
Practice Address - Zip Code:28759-5508
Practice Address - Country:US
Practice Address - Phone:828-891-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist