Healthcare Provider Details

I. General information

NPI: 1295932812
Provider Name (Legal Business Name): JAY JAY TAN LIMBO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 E HIGHLAND RD
HIGHLAND MI
48356-2730
US

IV. Provider business mailing address

8284 HUMMINGBIRD
COMMERCE TWP MI
48382-2279
US

V. Phone/Fax

Practice location:
  • Phone: 248-887-4121
  • Fax: 248-887-6391
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302034276
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: