MEDICARE: TANIA C REVEGGINO SOSA DE PINTO R.PH.

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	5302042300	MI

General Provider Information

NPI Number	:	1952766347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIA C REVEGGINO SOSA DE PINTO R.PH.

Provider Business Mailing Address
First Line	:	3811 COOLIDGE HWY
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-1466
Country	:	US
Telephone Number	:	586-268-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	4135 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-5400
Country	:	US
Telephone Number	:	586-268-1888
Fax Number	:

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

Provider Enumeration Date	:	12/29/2015
Last Update Date	:	12/29/2015

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