Healthcare Provider Details

I. General information

NPI: 1194565796
Provider Name (Legal Business Name): ANDRE DRAPER MEEKS CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17330 GREYDALE AVE
DETROIT MI
48219-3248
US

IV. Provider business mailing address

21700 NORTHWESTERN HWY
SOUTHFIELD MI
48075-4906
US

V. Phone/Fax

Practice location:
  • Phone: 855-445-4554
  • Fax:
Mailing address:
  • Phone: 855-445-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303042236
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: