1508897190 NPI number — MR. CRAIG RICHARD TETREAU BS PHARMACY

Table of content: MR. CRAIG RICHARD TETREAU BS PHARMACY (NPI 1508897190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508897190 NPI number — MR. CRAIG RICHARD TETREAU BS PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TETREAU
Provider First Name:
CRAIG
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BS PHARMACY
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TETREAU
Provider Other First Name:
CRAIG
Provider Other Middle Name:
RICHARD
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMACIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508897190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7041 CHARLES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIGEON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48755-9677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-453-2852
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
168 N. CASEVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIGEON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-453-2535
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  5302025179 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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