MEDICARE: MR. THOMAS A. MAGNIFICO 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	5302030831	MI
2	183500000X	Pharmacist	RP032139L	PA

General Provider Information

NPI Number	:	1407859457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS A. MAGNIFICO RPH

Provider Business Mailing Address
First Line	:	5455 RANGER HILLS DR SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-6443
Country	:	US
Telephone Number	:	616-498-4432
Fax Number	:

Provider Business Practice Location Address
First Line	:	4021 CASCADE RD SE
Second Line	:	SUITE 50
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2177
Country	:	US
Telephone Number	:	616-974-9792
Fax Number	:	616-464-3469

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/04/2017

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