MEDICARE: MR. WALTER VICTOR MAIKRANZ 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	26014087	IN

General Provider Information

NPI Number	:	1679761191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WALTER VICTOR MAIKRANZ RPH

Provider Business Mailing Address
First Line	:	6326 SALGE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-2460
Country	:	US
Telephone Number	:	260-486-2557
Fax Number	:	260-486-2557

Provider Business Practice Location Address
First Line	:	6326 SALGE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-2460
Country	:	US
Telephone Number	:	260-486-2557
Fax Number	:	260-486-2557

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

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	10/10/2007

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