Individual
MR. JOHN MATTHEW LASSILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
102 SUPERIOR AVE, BARAGA, MI 49908-9673
(906) 353-4555
Mailing address
102 SUPERIOR AVE, BARAGA, MI 49908-9673
(906) 353-4555
(906) 353-8066
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302031267
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5302031267
STATE OF MICHIGAN-BOARD OF PHARMACY
MI
Enumeration date
07/10/2013
Last updated
07/10/2013
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