Provider Demographics
NPI:1104426394
Name:DUCHEMIN, MARCUS (PHARMD)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:DUCHEMIN
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 1:1309 E HACKBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-9604
Mailing Address - Country:US
Mailing Address - Phone:812-883-8722
Mailing Address - Fax:812-883-8709
Practice Address - Street 1:1309 E HACKBERRY ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-9604
Practice Address - Country:US
Practice Address - Phone:812-883-8722
Practice Address - Fax:812-883-8709
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023048A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist