MEDICARE: MR. ROBERT P BUSAKOWSKI RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302022940	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5302022940	OTHER	MI	STATE LICENSE

General Provider Information

NPI Number	:	1043260375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT P BUSAKOWSKI RPH

Provider Business Mailing Address
First Line	:	124 W ROSS ST
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-1749
Country	:	US
Telephone Number	:	906-265-9616
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 W GENESEE ST
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-1437
Country	:	US
Telephone Number	:	906-265-2312
Fax Number	:	906-265-5608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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