Healthcare Provider Details

I. General information

NPI: 1699956201
Provider Name (Legal Business Name): DAVID JEROME MAJESTIC R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

IV. Provider business mailing address

42955 WHITESTONE CT
NORTHVILLE MI
48168-2061
US

V. Phone/Fax

Practice location:
  • Phone: 734-845-5108
  • Fax: 734-845-3214
Mailing address:
  • Phone: 734-420-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302024761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: