Healthcare Provider Details

I. General information

NPI: 1003107665
Provider Name (Legal Business Name): ERIC MICHAEL CLINTON PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 W GRAND RIVER AVE
BRIGHTON MI
48116-2904
US

IV. Provider business mailing address

9409 VAN ANTWERP RD
BRIGHTON MI
48116-6246
US

V. Phone/Fax

Practice location:
  • Phone: 810-220-5840
  • Fax:
Mailing address:
  • Phone: 810-231-3177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302037851
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: