MEDICARE: MR. MICHAEL R TORTORA RPH

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	18495	IA

General Provider Information

NPI Number	:	1164717336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL R TORTORA RPH

Provider Business Mailing Address
First Line	:	3400 EDGEWOOD RD SW
Second Line	:	TARGET PHARMACY STORE NUMBER (T-1771)
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52404-7214
Country	:	US
Telephone Number	:	319-396-4777
Fax Number	:	319-396-4777

Provider Business Practice Location Address
First Line	:	3400 EDGEWOOD RD SW
Second Line	:	TARGET PHARMACY STORE NUMBER (T-1771)
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52404-7214
Country	:	US
Telephone Number	:	319-396-4777
Fax Number	:	319-396-4777

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

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	06/15/2011

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