Healthcare Provider Details

I. General information

NPI: 1356754493
Provider Name (Legal Business Name): MR. GEORGE MICHAEL CHERGHEZAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GEORGE MICHAEL CHERGHEZAN RPH

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 M 89
PLAINWELL MI
49080-1135
US

IV. Provider business mailing address

310 E BRIDGE ST
PLAINWELL MI
49080-1722
US

V. Phone/Fax

Practice location:
  • Phone: 269-685-3833
  • Fax: 269-685-3765
Mailing address:
  • Phone: 269-685-3833
  • Fax: 269-685-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302026109
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: