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NPI Code Detail

MEDICARE: JACOB M COLLERAN PHARMD

MEDICARE: JACOB M COLLERAN PHARMD
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
1183500000XPharmacist5302411882MI

General Provider Information

NPI Number : 1487229597
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB M COLLERAN PHARMD
Provider Business Mailing Address
First Line : 6001 HIGHLAND RD
Second Line :
City : WHITE LAKE
State : MI
Zip : 48383-4302
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6001 HIGHLAND RD
Second Line :
City : WHITE LAKE
State : MI
Zip : 48383-4302
Country : US
Telephone Number : 248-889-6810
Fax Number : 248-889-6865
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2021
Last Update Date : 05/21/2021

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Directions to “ JACOB M COLLERAN PHARMD” Practice Location

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