Healthcare Provider Details

I. General information

NPI: 1770672867
Provider Name (Legal Business Name): KARI LYNN GELDERBLOOM CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 HUBBARD DR PHARMACY
DEARBORN MI
48126-2641
US

IV. Provider business mailing address

28481 RUSH ST
GARDEN CITY MI
48135-2135
US

V. Phone/Fax

Practice location:
  • Phone: 313-982-8245
  • Fax: 313-982-8322
Mailing address:
  • Phone: 734-421-4586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: