MEDICARE: WILLIAM SORENSEN

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	030168	MI

General Provider Information

NPI Number	:	1558924720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM SORENSEN

Provider Business Mailing Address
First Line	:	PO BOX 1247
Second Line	:
City	:	INDIAN RIVER
State	:	MI
Zip	:	49749-1247
Country	:	US
Telephone Number	:	989-306-4803
Fax Number	:

Provider Business Practice Location Address
First Line	:	522 E HOUGHTON AVE STE 102
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-1184
Country	:	US
Telephone Number	:	800-221-6355
Fax Number	:

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

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	04/15/2019

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