Healthcare Provider Details

I. General information

NPI: 1053975813
Provider Name (Legal Business Name): CONSTANCE LYNN CHOW PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4260 PLYMOUTH RD
ANN ARBOR MI
48109-2700
US

IV. Provider business mailing address

7255 BUNTON RD
YPSILANTI MI
48197-9416
US

V. Phone/Fax

Practice location:
  • Phone: 855-276-3002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302047230
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: