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NPI Code Detail

MEDICARE: MR. MICHAEL THOMAS MACKOWIAK RPH

MEDICARE: MR. MICHAEL THOMAS MACKOWIAK 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
1183500000XPharmacist11245-040WI
2183500000XPharmacistS010070AZ

General Provider Information

NPI Number : 1679841464
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL THOMAS MACKOWIAK RPH
Provider Business Mailing Address
First Line : 6292 S 27TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53221-4839
Country : US
Telephone Number : 414-761-0994
Fax Number : 414-761-1796
Provider Business Practice Location Address
First Line : 6292 S 27TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53221-4839
Country : US
Telephone Number : 414-761-0994
Fax Number : 414-761-1796
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2011
Last Update Date : 12/07/2011

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