Healthcare Provider Details

I. General information

NPI: 1851048334
Provider Name (Legal Business Name): STEVE DEMARCO WELLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST
DETROIT MI
48201-2153
US

IV. Provider business mailing address

4625 CHRYSLER DR
DETROIT MI
48201-1953
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-8230
  • Fax:
Mailing address:
  • Phone: 313-974-9137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5903010748
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: