Healthcare Provider Details

I. General information

NPI: 1962721704
Provider Name (Legal Business Name): FLAMUR VAKA RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7843 W VERNOR HWY
DETROIT MI
48209-1517
US

IV. Provider business mailing address

27 BROOKLINE LN
DEARBORN MI
48120-1037
US

V. Phone/Fax

Practice location:
  • Phone: 313-554-4511
  • Fax: 313-841-7240
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302031533
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: