Provider Demographics
NPI:1508818683
Name:MICHIENZI, TONINO F (RPH)
Entity Type:Individual
Prefix:
First Name:TONINO
Middle Name:F
Last Name:MICHIENZI
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 1:7774 PARK RIDGE DR SW
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9158
Mailing Address - Country:US
Mailing Address - Phone:616-828-7557
Mailing Address - Fax:
Practice Address - Street 1:2829 S DIVISION AVE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49548-1152
Practice Address - Country:US
Practice Address - Phone:616-248-9030
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist