=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184778037
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILLIP DUANE TOWNS R.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 10/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 HILL BRADY RD
-----------------------------------------------------
City | BATTLE CREEK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49037-5606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-963-5991
-----------------------------------------------------
Fax | 269-963-5992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6330 CARTER RD
-----------------------------------------------------
City | SPRING ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49283-9713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-750-3974
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5302030325
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------