MEDICARE: CARRIE CZECH 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	5302029794	MI

General Provider Information

NPI Number	:	1689958373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE CZECH RPH

Provider Business Mailing Address
First Line	:	2270 UNION LAKE RD
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-2254
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2270 UNION LAKE RD
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-2254
Country	:	US
Telephone Number	:	248-363-0436
Fax Number	:	248-363-0667

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

Provider Enumeration Date	:	09/29/2011
Last Update Date	:	09/29/2011

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Directions to “ CARRIE CZECH RPH” Practice Location

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