MEDICARE: CHONA TANTOCO FRANKLIN RPH

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	5302041139	MI

General Provider Information

NPI Number	:	1609351063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHONA TANTOCO FRANKLIN RPH

Provider Business Mailing Address
First Line	:	24800 HOOVER RD STE B
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-1965
Country	:	US
Telephone Number	:	586-486-5008
Fax Number	:	586-486-5744

Provider Business Practice Location Address
First Line	:	24800 HOOVER RD STE B
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-1965
Country	:	US
Telephone Number	:	586-486-5008
Fax Number	:	586-486-5744

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

Provider Enumeration Date	:	10/01/2018
Last Update Date	:	10/01/2018

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Directions to “ CHONA TANTOCO FRANKLIN RPH” Practice Location

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