MEDICARE: GORDON SHANE MCNEILL 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
1	183500000X	Pharmacist	5302027389	MI

General Provider Information

NPI Number	:	1386895738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON SHANE MCNEILL R.PH.

Provider Business Mailing Address
First Line	:	219 N MAIN ST
Second Line	:
City	:	NASHVILLE
State	:	MI
Zip	:	49073-9577
Country	:	US
Telephone Number	:	517-852-0845
Fax Number	:	517-852-0461

Provider Business Practice Location Address
First Line	:	219 N MAIN ST
Second Line	:
City	:	NASHVILLE
State	:	MI
Zip	:	49073-9577
Country	:	US
Telephone Number	:	517-852-0845
Fax Number	:	517-852-0461

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

Provider Enumeration Date	:	10/03/2008
Last Update Date	:	10/03/2008

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