MEDICARE: MS. ELINORE LOUISE HEGEDUS 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	5302025284	MI

General Provider Information

NPI Number	:	1982683033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELINORE LOUISE HEGEDUS RPH

Provider Business Mailing Address
First Line	:	218 DOUGLAS CT
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-1927
Country	:	US
Telephone Number	:	616-847-6040
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 REMEMBRANCE RD NW
Second Line	:
City	:	WALKER
State	:	MI
Zip	:	49534-7744
Country	:	US
Telephone Number	:	616-791-0383
Fax Number	:	616-791-8343

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

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	07/08/2007

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