MEDICARE: MICHAEL E CARBONNEAU 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
1	183500000X	Pharmacist	117990	MN

General Provider Information

NPI Number	:	1508141896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E CARBONNEAU PHARMD

Provider Business Mailing Address
First Line	:	202 S KNISS AVE
Second Line	:
City	:	LUVERNE
State	:	MN
Zip	:	56156-1775
Country	:	US
Telephone Number	:	507-283-9549
Fax Number	:	507-283-9540

Provider Business Practice Location Address
First Line	:	202 S KNISS AVE
Second Line	:
City	:	LUVERNE
State	:	MN
Zip	:	56156-1775
Country	:	US
Telephone Number	:	507-283-9549
Fax Number	:	507-283-9540

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

Provider Enumeration Date	:	10/18/2011
Last Update Date	:	06/25/2014

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