Individual
MICHAEL KERMODE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
2005 W. BROADWAY, PRINCETON, IN 47670
(812) 386-7672
(812) 386-5155
Mailing address
621 S. OLD PATOKA RD, PATOKA, IN 47666
(812) 779-5417
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26016063A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26016063A
IN LICENSE NUMBER
IN
Enumeration date
05/14/2007
Last updated
07/08/2007
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