Healthcare Provider Details

I. General information

NPI: 1932212792
Provider Name (Legal Business Name): GLORIA H DUNN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 JOHN R ST
DETROIT MI
48201-1916
US

IV. Provider business mailing address

37339 INGLESIDE ST
CLINTON TWP MI
48036-2624
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-4312
  • Fax: 313-576-1105
Mailing address:
  • Phone: 586-463-9273
  • Fax: 313-576-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302024678
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: