=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649569492
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL ZENGERLE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2011
-----------------------------------------------------
Last Update Date | 04/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1810 MAPLEWOOD AVE
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48506-3780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-232-6423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13137 LOG CABIN PT
-----------------------------------------------------
City | FENTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48430-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-523-5587
-----------------------------------------------------
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 | 5302021586
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------