MEDICARE: LON STEVEN RUPPEL 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	5302026224	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5302026224	OTHER	MI	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1467903492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LON STEVEN RUPPEL RPH

Provider Business Mailing Address
First Line	:	5880 S BOB WHITE DRIVE
Second Line	:
City	:	KIMBALL
State	:	MI
Zip	:	48074
Country	:	US
Telephone Number	:	810-941-8286
Fax Number	:

Provider Business Practice Location Address
First Line	:	4845 24TH AVE
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3407
Country	:	US
Telephone Number	:	810-385-7747
Fax Number	:	810-385-4679

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

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	10/14/2016

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Directions to “ LON STEVEN RUPPEL RPH” Practice Location

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