Healthcare Provider Details

I. General information

NPI: 1538346028
Provider Name (Legal Business Name): ANN ARBOR MARKET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N MAPLE RD
ANN ARBOR MI
48103-2824
US

IV. Provider business mailing address

30777 NORTHWESTERN HWY SUITE 301
FARMINGTON HILLS MI
48334-2549
US

V. Phone/Fax

Practice location:
  • Phone: 734-827-3000
  • Fax: 734-827-9445
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008788
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATT JONNA
Title or Position: OWNER
Credential:
Phone: 248-706-1600