Healthcare Provider Details

I. General information

NPI: 1801809165
Provider Name (Legal Business Name): THOMAS D. MEEHAN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2864 ASHMUN ST
SAULT SAINTE MARIE MI
49783-3740
US

IV. Provider business mailing address

15857 S MACKINAC TRL P.O. BOX 164
KINROSS MI
49752-9138
US

V. Phone/Fax

Practice location:
  • Phone: 906-632-5236
  • Fax: 906-632-5296
Mailing address:
  • Phone: 906-495-7137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302026332
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: