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General NPI Number Information
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NPI Number | 1467721027
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Entity Type | Individual
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Provider Name | MICHAEL ALAN SEVERN CPHT
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Gender | Male
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Dates
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Enumeration Date | 12/27/2011
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 2750 S PRIEST DR
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City | TEMPE
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State | AZ
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Zip | 85282-3339
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Country | US
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Telephone | 480-736-4472
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Fax |
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Provider Business Mailing Address
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Address Line | 12422 W SHARON DR
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City | EL MIRAGE
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State | AZ
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Zip | 85335-7257
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Country | US
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Telephone | 602-819-9453
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 7505
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License Number State | AZ
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