Healthcare Provider Details

I. General information

NPI: 1851063895
Provider Name (Legal Business Name): MARNA MUSIB GAPPY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 W 12 MILE RD
BERKLEY MI
48072-1414
US

IV. Provider business mailing address

7088 YARMOUTH DR
WEST BLOOMFIELD MI
48322-1077
US

V. Phone/Fax

Practice location:
  • Phone: 248-541-0158
  • Fax:
Mailing address:
  • Phone: 248-909-8628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302413830
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5315229034
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: