Healthcare Provider Details

I. General information

NPI: 1003923806
Provider Name (Legal Business Name): DAVID E TWISS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S MAIN ST
EATON RAPIDS MI
48827-1953
US

IV. Provider business mailing address

12506 PARK HILL LN
MARSHALL MI
49068-8708
US

V. Phone/Fax

Practice location:
  • Phone: 517-663-8331
  • Fax: 517-663-0010
Mailing address:
  • Phone: 269-781-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302024853
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: