Healthcare Provider Details

I. General information

NPI: 1316631534
Provider Name (Legal Business Name): BRETT SOMERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10772 W CARSON CITY RD
GREENVILLE MI
48838-9141
US

IV. Provider business mailing address

10772 W CARSON CITY RD
GREENVILLE MI
48838-9141
US

V. Phone/Fax

Practice location:
  • Phone: 616-754-5203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302039916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: