Healthcare Provider Details

I. General information

NPI: 1902105257
Provider Name (Legal Business Name): ANTHONY GERARD TOTORAITIS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 FOSTER AVE NE
GRAND RAPIDS MI
49505-3649
US

IV. Provider business mailing address

9377 CHERRY VALLEY AVE SE RITE-AID #1532
CALEDONIA MI
49316-8420
US

V. Phone/Fax

Practice location:
  • Phone: 616-204-9880
  • Fax:
Mailing address:
  • Phone: 616-891-1256
  • Fax: 616-891-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029165
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number113523
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: