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NPI Code Detail

MEDICARE: MR. MICHAEL ANTHONY PETERS R.PH

MEDICARE: MR. MICHAEL ANTHONY PETERS 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
1183500000XPharmacist5302410811MI

General Provider Information

NPI Number : 1467602904
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL ANTHONY PETERS R.PH
Provider Business Mailing Address
First Line : 846 CHATHAM DR
Second Line :
City : MILFORD
State : MI
Zip : 48381-2783
Country : US
Telephone Number : 248-529-6209
Fax Number :
Provider Business Practice Location Address
First Line : 620 N PONTIAC TRL
Second Line :
City : WALLED LAKE
State : MI
Zip : 48390-3448
Country : US
Telephone Number : 248-669-2776
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2008
Last Update Date : 09/21/2008

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