MEDICARE: MICHAEL ROBERT CHETOSKY 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	5302410558	MI

General Provider Information

NPI Number	:	1518278191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ROBERT CHETOSKY R.PH.

Provider Business Mailing Address
First Line	:	35350 23 MILE RD
Second Line	:
City	:	NEW BALTIMORE
State	:	MI
Zip	:	48047-4436
Country	:	US
Telephone Number	:	586-725-3640
Fax Number	:	586-716-2448

Provider Business Practice Location Address
First Line	:	35350 23 MILE RD
Second Line	:
City	:	NEW BALTIMORE
State	:	MI
Zip	:	48047-4436
Country	:	US
Telephone Number	:	586-725-3640
Fax Number	:	586-716-2448

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

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	06/29/2010

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