Healthcare Provider Details

I. General information

NPI: 1033377619
Provider Name (Legal Business Name): BOBBY LEE HARRINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 14 MILE RD
CLAWSON MI
48017-2803
US

IV. Provider business mailing address

5600 FALMOUTH DR
TROY MI
48085-3269
US

V. Phone/Fax

Practice location:
  • Phone: 248-435-2410
  • Fax: 248-435-4538
Mailing address:
  • Phone: 248-879-6233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302022869
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: