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General NPI Number Information
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NPI Number | 1902105257
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Entity Type | Individual
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Provider Name | ANTHONY GERARD TOTORAITIS R.PH.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 2435 FOSTER AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-3649
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Country | US
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Telephone | 616-204-9880
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Fax |
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Provider Business Mailing Address
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Address Line | 9377 CHERRY VALLEY AVE SE RITE-AID #1532
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City | CALEDONIA
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State | MI
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Zip | 49316-8420
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Country | US
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Telephone | 616-891-1256
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Fax | 616-891-1124
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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 | 5302029165
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 113523
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License Number State | MN
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