Individual
MICHAEL GLEN DELUCENAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2304 LINCOLNWAY E, GOSHEN, IN 46526-6421
(574) 534-4483
Mailing address
8105 E NORTH RD, SYRACUSE, IN 46567-7500
(574) 528-0548
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26014270A
IN
Other
Enumeration date
11/10/2020
Last updated
11/10/2020
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