MEDICARE: MICHAEL PATE VANDERPOEL

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	38097	TX

General Provider Information

NPI Number	:	1366045619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL PATE VANDERPOEL

Provider Business Mailing Address
First Line	:	1070 WETLAND DR
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-1635
Country	:	US
Telephone Number	:	214-793-3365
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 W TRINITY MILLS RD STE 120
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-1384
Country	:	US
Telephone Number	:	800-273-3455
Fax Number	:

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

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	11/19/2020

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Directions to “ MICHAEL PATE VANDERPOEL ” Practice Location

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