MEDICARE: MR. BENJAMIN MARTIN GREATHOUSE PHARMD CANDIDATE

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	5302039706	MI

General Provider Information

NPI Number	:	1437418480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN MARTIN GREATHOUSE PHARMD CANDIDATE

Provider Business Mailing Address
First Line	:	2240 N CEDAR ST.
Second Line	:
City	:	HOLT
State	:	MI
Zip	:	48854-1201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 N CEDAR ST.
Second Line	:
City	:	HOLT
State	:	MI
Zip	:	48854-1201
Country	:	US
Telephone Number	:	517-694-1994
Fax Number	:

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

Provider Enumeration Date	:	05/11/2012
Last Update Date	:	05/11/2012

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Directions to “ MR. BENJAMIN MARTIN GREATHOUSE PHARMD CANDIDATE” Practice Location

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