Provider Demographics
NPI:1063648491
Name:NAGEL, JOHN ALLEN (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLEN
Last Name:NAGEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 S BAY VIEW TRL
Mailing Address - Street 2:B
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-9619
Mailing Address - Country:US
Mailing Address - Phone:231-271-4115
Mailing Address - Fax:
Practice Address - Street 1:321 N.ST.JOSEPH
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682
Practice Address - Country:US
Practice Address - Phone:231-271-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5032020949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302020949OtherBOARD OF PHARMACY