Healthcare Provider Details

I. General information

NPI: 1508276304
Provider Name (Legal Business Name): MR. CHRISTOPHER SUCHYTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41255 COCA COLA DR
BELLEVILLE MI
48111-1827
US

IV. Provider business mailing address

47601 BELMONT DR
BELLEVILLE MI
48111-1086
US

V. Phone/Fax

Practice location:
  • Phone: 734-391-2300
  • Fax: 734-374-4265
Mailing address:
  • Phone: 734-697-8897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302030355
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: