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General NPI Number Information
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NPI Number | 1487315024
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Entity Type | Individual
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Provider Name | BRENTON MICHAEL HEALAN PHARMACY TECHNICIAN
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Gender | Male
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Dates
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Enumeration Date | 01/05/2022
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 13916 S WEST BAY SHORE DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-6297
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Country | US
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Telephone | 231-946-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 902 N CEDAR ST
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City | KALKASKA
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State | MI
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Zip | 49646-8061
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Country | US
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Telephone | 231-258-2081
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Fax | 231-258-5883
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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 | 5303039060
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License Number State | MI
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