Provider Demographics
NPI:1710103205
Name:MAZUREK, CHERYL LEGAULT (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LEGAULT
Last Name:MAZUREK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:FRANCES
Other - Last Name:LEGAULT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:7966 S SCHOMBERG RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR
Mailing Address - State:MI
Mailing Address - Zip Code:49621-9702
Mailing Address - Country:US
Mailing Address - Phone:231-228-5084
Mailing Address - Fax:
Practice Address - Street 1:4000 EASTERN SKY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4051
Practice Address - Country:US
Practice Address - Phone:231-947-6921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist