Healthcare Provider Details

I. General information

NPI: 1336668474
Provider Name (Legal Business Name): JACOB BRANDON SALDANA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2017
Last Update Date: 09/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E MICHIGAN AVE
JACKSON MI
49202-3850
US

IV. Provider business mailing address

760 MERCURY DR
ALBION MI
49224-9103
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-9382
  • Fax:
Mailing address:
  • Phone: 517-936-6683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302041870
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: