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NPI Code Detail

MEDICARE: DOMINIC MARK SCORZIELLO RPH

MEDICARE: DOMINIC MARK SCORZIELLO 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
1183500000XPharmacist28RI01836400NJ
2183500000XPharmacist5302027977MI

General Provider Information

NPI Number : 1255574950
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIC MARK SCORZIELLO RPH
Provider Business Mailing Address
First Line : 800 LEONARD ST NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-4148
Country : US
Telephone Number : 616-458-8300
Fax Number : 616-458-3691
Provider Business Practice Location Address
First Line : 800 LEONARD ST NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-4148
Country : US
Telephone Number : 616-458-8300
Fax Number : 616-458-3691
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2009
Last Update Date : 04/30/2022

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