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NPI Code Detail

MEDICARE: JOSHUA JAN DE CASTRO RPH

MEDICARE: JOSHUA JAN DE CASTRO RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist64346TX
2183500000XPharmacist5302040172MI

General Provider Information

NPI Number : 1427682335
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA JAN DE CASTRO RPH
Provider Business Mailing Address
First Line : 2554 PARASOL DR
Second Line :
City : TROY
State : MI
Zip : 48083-2425
Country : US
Telephone Number : 616-450-6694
Fax Number :
Provider Business Practice Location Address
First Line : 800 LEONARD ST NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-4148
Country : US
Telephone Number : 616-458-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/29/2020
Last Update Date : 02/29/2020

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