=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811231855
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL LIMKEMANN RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2012
-----------------------------------------------------
Last Update Date | 06/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 965 E SUMMIT ST
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48381-1790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-714-5020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1007 MEM DR
-----------------------------------------------------
City | HOUGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49931-2485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-231-8007
-----------------------------------------------------
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 | 5302033821
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------