MEDICARE: MR. WILLIAM ROBERT PENCE 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	5302021449	MI

General Provider Information

NPI Number	:	1689959827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM ROBERT PENCE 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	:	248-363-0436
Fax Number	:	248-363-0667

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	:	10/19/2011
Last Update Date	:	10/19/2011

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