Healthcare Provider Details

I. General information

NPI: 1669563359
Provider Name (Legal Business Name): SIMON MICHAEL CRONIN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JOHN R ST
DETROIT MI
48201-2013
US

IV. Provider business mailing address

6103 JASMINE DR
WALLED LAKE MI
48390-5812
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-8804
  • Fax: 313-576-8811
Mailing address:
  • Phone: 248-926-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302025919
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: