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NPI Code Detail

MEDICARE: MS. MARIA THERESA FEDOR RPH

MEDICARE: MS. MARIA THERESA FEDOR 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
1183500000XPharmacist26271MI

General Provider Information

NPI Number : 1861636912
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIA THERESA FEDOR RPH
Provider Business Mailing Address
First Line : 1026 N MAIN ST
Second Line :
City : ROYAL OAK
State : MI
Zip : 48067-1317
Country : US
Telephone Number : 248-546-4620
Fax Number : 248-546-8191
Provider Business Practice Location Address
First Line : 1026 N MAIN ST
Second Line :
City : ROYAL OAK
State : MI
Zip : 48067-1317
Country : US
Telephone Number : 248-546-4620
Fax Number : 248-546-8191
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2009
Last Update Date : 04/20/2009

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Directions to “ MS. MARIA THERESA FEDOR RPH” Practice Location

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