MEDICARE: DELTON FAMILY PHARMACY

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	333600000X	Pharmacy	5301008076	MI
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2333932	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1386758365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTON FAMILY PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	DELTON
State	:	MI
Zip	:	49046-0190
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 MAPLE ST
Second Line	:
City	:	DELTON
State	:	MI
Zip	:	49046
Country	:	US
Telephone Number	:	269-623-5250
Fax Number	:	269-623-5140

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MICHAEL HOLTZ
Credential	:	RPH
Telephone Number	:	269-672-7774

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	09/11/2025

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Directions to “DELTON FAMILY PHARMACY ” Practice Location

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