MEDICARE: ALYSSA SCRIBNER

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	5302042635	MI

General Provider Information

NPI Number	:	1720513385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA SCRIBNER

Provider Business Mailing Address
First Line	:	725 N HARRISON ST
Second Line	:
City	:	LUDINGTON
State	:	MI
Zip	:	49431-1428
Country	:	US
Telephone Number	:	231-510-5122
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 WASHINGTON AVE
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49423-7131
Country	:	US
Telephone Number	:	616-396-0098
Fax Number	:

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

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	06/21/2020

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Directions to “ ALYSSA SCRIBNER ” Practice Location

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