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NPI Code Detail

MEDICARE: ANNAMARIE PORCARI MATA PHARMD

MEDICARE: ANNAMARIE PORCARI MATA PHARMD
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
1183500000XPharmacist5302026821MI

General Provider Information

NPI Number : 1487938445
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNAMARIE PORCARI MATA PHARMD
Provider Business Mailing Address
First Line : 44300 FORD RD
Second Line :
City : CANTON
State : MI
Zip : 48187-3169
Country : US
Telephone Number : 734-459-3875
Fax Number :
Provider Business Practice Location Address
First Line : 44300 FORD RD
Second Line :
City : CANTON
State : MI
Zip : 48187-3169
Country : US
Telephone Number : 734-459-3875
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2011
Last Update Date : 10/07/2011

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Directions to “ ANNAMARIE PORCARI MATA PHARMD” Practice Location

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