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NPI Code Detail

MEDICARE: MR. JOHN ANDREW ISERHOTH III R.PH.

MEDICARE: MR. JOHN ANDREW ISERHOTH III R.PH.
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
1183500000XPharmacist5302028909MI

General Provider Information

NPI Number : 1265730501
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN ANDREW ISERHOTH III R.PH.
Provider Business Mailing Address
First Line : 6638 S SUMMERTON RD
Second Line :
City : SHEPHERD
State : MI
Zip : 48883-9308
Country : US
Telephone Number : 989-400-1353
Fax Number :
Provider Business Practice Location Address
First Line : 117 N MISSION ST
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-1819
Country : US
Telephone Number : 989-772-7677
Fax Number : 989-773-0663
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2011
Last Update Date : 03/10/2011

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