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General NPI Number Information
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NPI Number | 1376840165
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Entity Type | Individual
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Provider Name | MICHAEL JOHN MCNAMARA RPH
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Gender | Male
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 1151 S OTSEGO AVE
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City | GAYLORD
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State | MI
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Zip | 49735-1789
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Country | US
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Telephone | 989-732-8990
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Fax |
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Provider Business Mailing Address
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Address Line | 615 S ROBERTS RD
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City | GRAYLING
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State | MI
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Zip | 49738-7009
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Country | US
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Telephone | 989-348-7735
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302024588
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License Number State | MI
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