Healthcare Provider Details

I. General information

NPI: 1861619579
Provider Name (Legal Business Name): EMILY ROSE HEIRES CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 GREEN RD
ANN ARBOR MI
48105-2553
US

IV. Provider business mailing address

819 N HUGHES RD
HOWELL MI
48843-9124
US

V. Phone/Fax

Practice location:
  • Phone: 734-994-7246
  • Fax: 734-994-0638
Mailing address:
  • Phone: 517-546-7254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number380101061156085
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: