Provider Demographics
NPI:1093976581
Name:VETTEL, MICHAEL L (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:VETTEL
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 1:620 PARK AVE N
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1143
Mailing Address - Country:US
Mailing Address - Phone:218-732-7087
Mailing Address - Fax:
Practice Address - Street 1:620 PARK AVE N
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1143
Practice Address - Country:US
Practice Address - Phone:218-732-7087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist