MEDICARE: ANGELA MICHIENZI RPH

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	5302028358	MI

General Provider Information

NPI Number	:	1396025995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MICHIENZI RPH

Provider Business Mailing Address
First Line	:	7774 PARK RIDGE DR SW
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-9158
Country	:	US
Telephone Number	:	616-662-1085
Fax Number	:

Provider Business Practice Location Address
First Line	:	7774 PARK RIDGE DR SW
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-9158
Country	:	US
Telephone Number	:	616-662-1085
Fax Number	:

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

Provider Enumeration Date	:	08/26/2011
Last Update Date	:	08/26/2011

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