MEDICARE: LEVANDOWSKI, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	5301006733	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2357906	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1053482075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEVANDOWSKI, LLC

Provider Business Mailing Address
First Line	:	1619 W GRAND RIVER AVE
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-1801
Country	:	US
Telephone Number	:	517-347-1458
Fax Number	:	517-347-2449

Provider Business Practice Location Address
First Line	:	1619 W GRAND RIVER AVE
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-1801
Country	:	US
Telephone Number	:	517-347-1458
Fax Number	:	517-347-2449

Authorized Official
Title or Position	:	DIR OF PHRMCY
Name	:	CALVIN HELMICK
Credential	:	RPH
Telephone Number	:	577-887-1877

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	02/15/2008

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Directions to “LEVANDOWSKI, LLC ” Practice Location

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