MEDICARE: STEPHEN FRANCIS WOLTANSKI 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	1835G0303X	Geriatric Pharmacist	5302020252	MI

General Provider Information

NPI Number	:	1962524710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN FRANCIS WOLTANSKI RPH

Provider Business Mailing Address
First Line	:	PO BOX 105
Second Line	:
City	:	NEW ERA
State	:	MI
Zip	:	49446-0105
Country	:	US
Telephone Number	:	231-894-6408
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 WEST M20
Second Line	:
City	:	NEW ERA
State	:	MI
Zip	:	49446
Country	:	US
Telephone Number	:	231-861-6942
Fax Number	:

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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