MEDICARE: MICHAEL LAROSA

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	PR13007	ME

General Provider Information

NPI Number	:	1174951073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LAROSA

Provider Business Mailing Address
First Line	:	665 ROOSEVELT TRL
Second Line	:
City	:	NAPLES
State	:	ME
Zip	:	04055-5322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	665 ROOSEVELT TRL
Second Line	:
City	:	NAPLES
State	:	ME
Zip	:	04055-5322
Country	:	US
Telephone Number	:	207-693-3937
Fax Number	:

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

Provider Enumeration Date	:	10/31/2013
Last Update Date	:	10/31/2013

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