Healthcare Provider Details

I. General information

NPI: 1790699676
Provider Name (Legal Business Name): MONIKA QAFKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8089 LAPEER RD
DAVISON MI
48423-2529
US

IV. Provider business mailing address

8089 LAPEER RD
DAVISON MI
48423-2529
US

V. Phone/Fax

Practice location:
  • Phone: 810-658-5410
  • Fax: 810-658-5465
Mailing address:
  • Phone: 810-658-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302419351
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: