MEDICARE: MR. GEORGE NICHOLAS LEVENTIS 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	5302025108	MI

General Provider Information

NPI Number	:	1811086713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE NICHOLAS LEVENTIS RPH

Provider Business Mailing Address
First Line	:	29138 SHENANDOAH DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-2450
Country	:	US
Telephone Number	:	248-489-7177
Fax Number	:	248-333-0273

Provider Business Practice Location Address
First Line	:	1525 S OPDYKE RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-1042
Country	:	US
Telephone Number	:	248-333-0222
Fax Number	:	248-333-0273

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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