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NPI Code Detail

MEDICARE: MR. PHIL JOSEPH DEMEULENAERE III RPH

MEDICARE:  MR. PHIL JOSEPH DEMEULENAERE III 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
1183500000XPharmacist26019560AIN
2183500000XPharmacist5302030476MI

General Provider Information

NPI Number : 1235411133
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PHIL JOSEPH DEMEULENAERE III RPH
Provider Business Mailing Address
First Line : 3391 CEDAR LN
Second Line :
City : BRIDGMAN
State : MI
Zip : 49106-9739
Country : US
Telephone Number : 269-465-9203
Fax Number :
Provider Business Practice Location Address
First Line : 1710 W JOHN BEERS RD
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-9409
Country : US
Telephone Number : 269-429-1153
Fax Number : 269-429-1495
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2011
Last Update Date : 03/04/2016

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Directions to “ MR. PHIL JOSEPH DEMEULENAERE III RPH” Practice Location

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