MEDICARE: JOEL ORUESEFIETA BOKAN 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
1	183500000X	Pharmacist	5302037796530	MI

General Provider Information

NPI Number	:	1528523529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL ORUESEFIETA BOKAN RPH

Provider Business Mailing Address
First Line	:	29985 LACY DR
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48186-7349
Country	:	US
Telephone Number	:	313-258-1826
Fax Number	:	947-222-8976

Provider Business Practice Location Address
First Line	:	13641 E 7 MILE RD STE 2
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-2257
Country	:	US
Telephone Number	:	586-222-9215
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2019
Last Update Date	:	02/04/2019

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