MEDICARE: MR. MYRON GEORGE DIDYK REGISTERED 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	5302029493	MI

General Provider Information

NPI Number	:	1063702751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MYRON GEORGE DIDYK REGISTERED RPH

Provider Business Mailing Address
First Line	:	7421 E M 113
Second Line	:
City	:	KINGSLEY
State	:	MI
Zip	:	49649-9628
Country	:	US
Telephone Number	:	231-263-5997
Fax Number	:

Provider Business Practice Location Address
First Line	:	13916 S WEST BAY SHORE DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-6264
Country	:	US
Telephone Number	:	231-946-7400
Fax Number	:

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

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	04/14/2011

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