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General NPI Number Information
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NPI Number | 1881295533
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Entity Type | Individual
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Provider Name | MICHAEL JOHN WITTEN RPH
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Gender | Male
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Dates
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Enumeration Date | 11/07/2020
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Last Update Date | 11/07/2020
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Provider Practice Location Address
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Address Line | 1850 ANDERSON RD
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City | PETOSKEY
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State | MI
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Zip | 49770-8893
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Country | US
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Telephone | 231-439-0071
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Fax |
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Provider Business Mailing Address
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Address Line | 3825 BEHLING RD
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City | BOYNE CITY
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State | MI
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Zip | 49712-9601
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Country | US
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Telephone | 231-675-2078
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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 | 5302410683
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License Number State | MI
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