MEDICARE: MRS. CHERYL LEGAULT MAZUREK 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	5302020813	MI

General Provider Information

NPI Number	:	1710103205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL LEGAULT MAZUREK RPH

Provider Business Mailing Address
First Line	:	7966 S SCHOMBERG RD
Second Line	:
City	:	CEDAR
State	:	MI
Zip	:	49621-9702
Country	:	US
Telephone Number	:	231-228-5084
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 EASTERN SKY DR
Second Line	:	SUITE 1
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4051
Country	:	US
Telephone Number	:	231-947-6921
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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