MEDICARE: MR. STEVEN EDWARD WOLTER 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	5301008446	MI

General Provider Information

NPI Number	:	1497893267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN EDWARD WOLTER R. PH.

Provider Business Mailing Address
First Line	:	1368 BUCKHORN DR
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-9755
Country	:	US
Telephone Number	:	269-665-0230
Fax Number	:

Provider Business Practice Location Address
First Line	:	1485 SOUTH M-139
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49023-0547
Country	:	US
Telephone Number	:	269-934-0119
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. STEVEN EDWARD WOLTER R. PH.” Practice Location

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