MEDICARE: DR. MICHAEL ANTHONY WITHEROW JR. PHARM.D., 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	PS50674	FL

General Provider Information

NPI Number	:	1861825333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANTHONY WITHEROW JR. PHARM.D., RPH.

Provider Business Mailing Address
First Line	:	622 WIGGINS BAY DR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34110-6020
Country	:	US
Telephone Number	:	330-219-0936
Fax Number	:

Provider Business Practice Location Address
First Line	:	11494 BONITA BEACH RD SE # 96
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-5906
Country	:	US
Telephone Number	:	239-992-3894
Fax Number	:

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

Provider Enumeration Date	:	08/19/2013
Last Update Date	:	08/19/2013

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