Healthcare Provider Details

I. General information

NPI: 1982137329
Provider Name (Legal Business Name): JADE ALEXANDRA PFUND PHARM.D., RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 RIVERSIDE AVE
ADRIAN MI
49221-1446
US

IV. Provider business mailing address

818 RIVERSIDE AVE
ADRIAN MI
49221-1446
US

V. Phone/Fax

Practice location:
  • Phone: 517-265-0900
  • Fax:
Mailing address:
  • Phone: 517-265-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number5302041131
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: