MEDICARE: MR. MICHAEL TAKACH R.PH.

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	4385	ME
2	183500000X	Pharmacist	R1372	ME

General Provider Information

NPI Number	:	1770543639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL TAKACH R.PH.

Provider Business Mailing Address
First Line	:	16 OLDE FORT RD
Second Line	:
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-1813
Country	:	US
Telephone Number	:	207-329-9977
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 OLDE FORT RD
Second Line	:
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-1813
Country	:	US
Telephone Number	:	207-329-9977
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	01/14/2013

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