MEDICARE: CATHERINE WIECKOWSKI

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	5302032665	MI

General Provider Information

NPI Number	:	1780081216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE WIECKOWSKI

Provider Business Mailing Address
First Line	:	45460 MARKET STREET
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48315
Country	:	US
Telephone Number	:	586-580-2002
Fax Number	:

Provider Business Practice Location Address
First Line	:	45460 MARKET ST
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48315-6224
Country	:	US
Telephone Number	:	586-580-2002
Fax Number	:

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

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	11/26/2014

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Directions to “ CATHERINE WIECKOWSKI ” Practice Location

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