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NPI Code Detail

MEDICARE: MICHAEL JOSEPH BUSUTTIL RPH

MEDICARE: MICHAEL JOSEPH BUSUTTIL 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
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist26019555AIN
2183500000XPharmacist26019555AIN

General Provider Information

NPI Number : 1477199370
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL JOSEPH BUSUTTIL RPH
Provider Business Mailing Address
First Line : 4202 S EAST ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-1416
Country : US
Telephone Number : 317-781-4258
Fax Number : 317-781-4260
Provider Business Practice Location Address
First Line : 4202 S EAST ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-1416
Country : US
Telephone Number : 317-781-4258
Fax Number : 317-781-4258
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2019
Last Update Date : 01/24/2020

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