MEDICARE: MR. SCOTT CARL REUSZE 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	5302029911	MI

General Provider Information

NPI Number	:	1255462818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT CARL REUSZE RPH

Provider Business Mailing Address
First Line	:	3921 FLINT RD
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-4903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8701 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2904
Country	:	US
Telephone Number	:	810-220-5840
Fax Number	:	810-220-0283

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/08/2007

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