MEDICARE: SCOTT ANDRUS PHARMD

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	5302038684	MI

General Provider Information

NPI Number	:	1750665725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT ANDRUS PHARMD

Provider Business Mailing Address
First Line	:	56805 VAN DYKE AVE
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48316-5894
Country	:	US
Telephone Number	:	586-786-1856
Fax Number	:	586-786-5705

Provider Business Practice Location Address
First Line	:	56805 VAN DYKE AVE
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48316-5894
Country	:	US
Telephone Number	:	586-786-1856
Fax Number	:	586-786-5705

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

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	10/07/2011

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Directions to “ SCOTT ANDRUS PHARMD” Practice Location

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