Provider Demographics
NPI:1902105257
Name:TOTORAITIS, ANTHONY GERARD (RPH)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GERARD
Last Name:TOTORAITIS
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 1:9377 CHERRY VALLEY AVE SE
Mailing Address - Street 2:RITE-AID #1532
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-8420
Mailing Address - Country:US
Mailing Address - Phone:616-891-1256
Mailing Address - Fax:616-891-1124
Practice Address - Street 1:2435 FOSTER AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3649
Practice Address - Country:US
Practice Address - Phone:616-204-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029165183500000X
MN113523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist