Provider Demographics
NPI:1871715318
Name:DEWEY, MICHAEL WAYNE (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WAYNE
Last Name:DEWEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 LINCOLN AVE N.E.
Mailing Address - Street 2:P.O. BOX 427
Mailing Address - City:TWIN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56584-0427
Mailing Address - Country:US
Mailing Address - Phone:218-584-5377
Mailing Address - Fax:218-584-8340
Practice Address - Street 1:207 LINCOLN AVE. N.E.
Practice Address - Street 2:
Practice Address - City:TWIN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:56584
Practice Address - Country:US
Practice Address - Phone:218-584-5377
Practice Address - Fax:218-584-8340
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist