MEDICARE: CRISANTA VOGAN

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	5302032972	MI

General Provider Information

NPI Number	:	1376842518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISANTA VOGAN

Provider Business Mailing Address
First Line	:	2241 FILINOW DR
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49444-4051
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2580 LAKE AVE
Second Line	:
City	:	N MUSKEGON
State	:	MI
Zip	:	49445-3323
Country	:	US
Telephone Number	:	231-744-2401
Fax Number	:	231-744-9951

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

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	03/25/2011

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Directions to “ CRISANTA VOGAN ” Practice Location

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