MEDICARE: ANGELI CERTA PHARM.D.

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	5302026310	MI

General Provider Information

NPI Number	:	1598052433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELI CERTA PHARM.D.

Provider Business Mailing Address
First Line	:	52375 N MAIN ST
Second Line	:
City	:	MATTAWAN
State	:	MI
Zip	:	49071-9332
Country	:	US
Telephone Number	:	269-668-6205
Fax Number	:	269-668-5071

Provider Business Practice Location Address
First Line	:	52375 N MAIN ST
Second Line	:
City	:	MATTAWAN
State	:	MI
Zip	:	49071-9332
Country	:	US
Telephone Number	:	269-668-6205
Fax Number	:	269-668-5071

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

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/29/2011

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Directions to “ ANGELI CERTA PHARM.D.” Practice Location

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