MEDICARE: GWENDOLYN ANN CHIVERS 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	5302021425	MI

General Provider Information

NPI Number	:	1659384923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN ANN CHIVERS RPH

Provider Business Mailing Address
First Line	:	207 FLETCHER
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48109-1050
Country	:	US
Telephone Number	:	734-763-3422
Fax Number	:	734-647-8777

Provider Business Practice Location Address
First Line	:	207 FLETCHER
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48109-1050
Country	:	US
Telephone Number	:	734-763-3422
Fax Number	:	734-647-8777

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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