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NPI Code Detail

MEDICARE: MR. DAVID L PONTIOUS R.PH.

MEDICARE: MR. DAVID L PONTIOUS 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
1183500000XPharmacist5302039037MI
2183500000XPharmacist040865MO
3183500000XPharmacist1-10442KS

General Provider Information

NPI Number : 1275815797
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID L PONTIOUS R.PH.
Provider Business Mailing Address
First Line : 1029 M 37 S
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49685-8508
Country : US
Telephone Number : 231-943-3147
Fax Number :
Provider Business Practice Location Address
First Line : 1029 M 37 S
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49685-8508
Country : US
Telephone Number : 231-943-3147
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2011
Last Update Date : 09/10/2011

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