Healthcare Provider Details

I. General information

NPI: 1295844066
Provider Name (Legal Business Name): CHRISTOPHER GERARD ROOS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 JUNCTION ST
DETROIT MI
48209-2110
US

IV. Provider business mailing address

42695 WIMBLETON WAY
NOVI MI
48377-2044
US

V. Phone/Fax

Practice location:
  • Phone: 313-843-8770
  • Fax: 313-843-8775
Mailing address:
  • Phone: 248-926-8696
  • Fax: 248-926-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302026095
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: