MEDICARE: DEAN ROBERT MCCROSSEN

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	5315108294	MI

General Provider Information

NPI Number	:	1083216667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAN ROBERT MCCROSSEN

Provider Business Mailing Address
First Line	:	4269 SPRINGBROOK DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-2924
Country	:	US
Telephone Number	:	248-930-3716
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 S ADAMS RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-5518
Country	:	US
Telephone Number	:	248-853-2174
Fax Number	:

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

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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