MEDICARE: FAWN PAPATRIANTAFYLLOU

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	5302039462	MI

General Provider Information

NPI Number	:	1639561608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAWN PAPATRIANTAFYLLOU

Provider Business Mailing Address
First Line	:	300 E F ST
Second Line	:
City	:	IRON MOUNTAIN
State	:	MI
Zip	:	49801-3442
Country	:	US
Telephone Number	:	906-774-0563
Fax Number	:	906-774-1186

Provider Business Practice Location Address
First Line	:	300 E F ST
Second Line	:
City	:	IRON MOUNTAIN
State	:	MI
Zip	:	49801-3442
Country	:	US
Telephone Number	:	906-774-0563
Fax Number	:	906-774-1186

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

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	02/26/2015

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