MEDICARE: MS. NANCY MICHAEL

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	5302038617	MI

General Provider Information

NPI Number	:	1881978740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY MICHAEL

Provider Business Mailing Address
First Line	:	5103 PINEHURST LN
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2611
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 DIXIE HWY
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48329-1705
Country	:	US
Telephone Number	:	248-673-6710
Fax Number	:

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

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	10/10/2011

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