MEDICARE: DELTON FAMILY PHARMACY INC

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	3336C0003X	Community/Retail Pharmacy	5301008076	MI

General Provider Information

NPI Number	:	1104992734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTON FAMILY PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	DELTON
State	:	MI
Zip	:	49046-0190
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	338 N GROVE ST
Second Line	:
City	:	DELTON
State	:	MI
Zip	:	49046-9601
Country	:	US
Telephone Number	:	269-623-5250
Fax Number	:	269-623-5140

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MICHAEL HOLTZ
Credential	:	RPH
Telephone Number	:	269-623-5250

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	10/14/2014

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Directions to “DELTON FAMILY PHARMACY INC ” Practice Location

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