Healthcare Provider Details

I. General information

NPI: 1588417943
Provider Name (Legal Business Name): DINA MARIE STORNELLO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1982 TRAVER RD APT 105
ANN ARBOR MI
48105-1270
US

IV. Provider business mailing address

1982 TRAVER RD APT 105
ANN ARBOR MI
48105-1270
US

V. Phone/Fax

Practice location:
  • Phone: 734-929-2293
  • Fax:
Mailing address:
  • Phone: 734-929-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302410722
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: