MEDICARE: STEVEN MICHAEL TILLERY

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	9906	AL
2	183500000X	Pharmacist	RPH019056	GA

General Provider Information

NPI Number	:	1871830844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN MICHAEL TILLERY

Provider Business Mailing Address
First Line	:	5408 SUMMERVILLE RD
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-7480
Country	:	US
Telephone Number	:	334-291-8533
Fax Number	:	334-291-8532

Provider Business Practice Location Address
First Line	:	5408 SUMMERVILLE RD
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-7480
Country	:	US
Telephone Number	:	334-291-8533
Fax Number	:	334-291-8532

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

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	01/11/2013

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