Healthcare Provider Details

I. General information

NPI: 1992004139
Provider Name (Legal Business Name): BECKY ANN MACBLAIN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 N CORNING ST
FARWELL MI
48622-9737
US

IV. Provider business mailing address

146 N CORNING ST
FARWELL MI
48622-9737
US

V. Phone/Fax

Practice location:
  • Phone: 989-588-2599
  • Fax: 989-588-3024
Mailing address:
  • Phone: 989-588-2599
  • Fax: 989-588-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302023484
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: