Individual
CHARLES MICHAEL CHUCTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1950 W CENTRE AVE, PORTAGE, MI 49024-5334
(269) 321-0664
Mailing address
1950 W CENTRE AVE, PORTAGE, MI 49024-5334
(269) 321-0664
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302023408
MI
Other
Enumeration date
03/19/2011
Last updated
03/19/2011
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