Healthcare Provider Details

I. General information

NPI: 1942652953
Provider Name (Legal Business Name): RAFAEL CHAVEZ R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N JACKSON ST
JACKSON MI
49201-1266
US

IV. Provider business mailing address

2603 JACKSON AVE
ANN ARBOR MI
48103-3820
US

V. Phone/Fax

Practice location:
  • Phone: 517-748-5400
  • Fax: 517-748-5410
Mailing address:
  • Phone: 734-663-1362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302036706
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: