Healthcare Provider Details

I. General information

NPI: 1578862355
Provider Name (Legal Business Name): ROBYN ZICCARDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 03/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 E PIERSON RD
FLUSHING MI
48433-1816
US

IV. Provider business mailing address

5215 WHITTAKER TRL
LINDEN MI
48451-8928
US

V. Phone/Fax

Practice location:
  • Phone: 810-659-2940
  • Fax:
Mailing address:
  • Phone: 810-656-1159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029719
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: