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NPI Code Detail

MEDICARE: MICHELLE MARIE PROSKOVEC PHARMD

MEDICARE: MICHELLE MARIE PROSKOVEC PHARMD
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
1183500000XPharmacist19327IA

General Provider Information

NPI Number : 1902437668
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE MARIE PROSKOVEC PHARMD
Provider Business Mailing Address
First Line : 3410 USHERS RIDGE BLVD NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52411-2202
Country : US
Telephone Number : 319-310-1008
Fax Number :
Provider Business Practice Location Address
First Line : 4825 JOHNSON AVE NW
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52405-4207
Country : US
Telephone Number : 319-396-7419
Fax Number : 319-396-5916
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2020
Last Update Date : 01/31/2020

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