Healthcare Provider Details

I. General information

NPI: 1669742334
Provider Name (Legal Business Name): CHRISTINE MARY RENDON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 S TELEGRAPH RD
BLOOMFIELD TOWNSHIP MI
48302-0254
US

IV. Provider business mailing address

2343 S TELEGRAPH RD
BLOOMFIELD TOWNSHIP MI
48302-0254
US

V. Phone/Fax

Practice location:
  • Phone: 248-972-0725
  • Fax: 248-972-0570
Mailing address:
  • Phone: 248-972-0725
  • Fax: 248-972-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302026021
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: