Healthcare Provider Details

I. General information

NPI: 1083579437
Provider Name (Legal Business Name): AISWARYA DIVAGARAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E LAFAYETTE BLVD
DETROIT MI
48226-2927
US

IV. Provider business mailing address

328 DEMPSTER ST APT 2
EVANSTON IL
60202-1384
US

V. Phone/Fax

Practice location:
  • Phone: 313-225-8285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302413756
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: