Provider Demographics
NPI:1528578218
Name:CALVERT, MICHAEL AARON (RP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:AARON
Last Name:CALVERT
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4589
Mailing Address - Country:US
Mailing Address - Phone:308-632-3767
Mailing Address - Fax:308-632-0947
Practice Address - Street 1:3322 AVENUE I
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4589
Practice Address - Country:US
Practice Address - Phone:308-632-3767
Practice Address - Fax:308-632-0947
Is Sole Proprietor?:No
Enumeration Date:2017-10-07
Last Update Date:2017-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4574183500000X
NE10435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist