MEDICARE: MICHAEL LITLLE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP006604	WV

General Provider Information

NPI Number	:	1033565312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LITLLE PHARMD

Provider Business Mailing Address
First Line	:	200 MT. DECHANTAL RD
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003
Country	:	US
Telephone Number	:	304-233-5487
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MOUNT DE CHANTAL RD
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-6563
Country	:	US
Telephone Number	:	304-233-5487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2016
Last Update Date	:	05/05/2016

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