MEDICARE: DR. JUSTIN HAMPEL PHARMD

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	5302033854	MI

General Provider Information

NPI Number	:	1114039864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN HAMPEL PHARMD

Provider Business Mailing Address
First Line	:	7741 N SHERMAN RD
Second Line	:
City	:	BARRYTON
State	:	MI
Zip	:	49305-9606
Country	:	US
Telephone Number	:	989-382-7064
Fax Number	:

Provider Business Practice Location Address
First Line	:	352 N ROSS ST
Second Line	:
City	:	BEAVERTON
State	:	MI
Zip	:	48612-8165
Country	:	US
Telephone Number	:	989-435-7727
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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