Healthcare Provider Details

I. General information

NPI: 1326134289
Provider Name (Legal Business Name): DAVID ROBERT ANDERSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 DEXTER ST
MILAN MI
48160-1158
US

IV. Provider business mailing address

11160 DARLING RD
MILAN MI
48160-9115
US

V. Phone/Fax

Practice location:
  • Phone: 734-439-8877
  • Fax: 734-439-0010
Mailing address:
  • Phone: 734-439-8903
  • Fax: 734-439-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302033320
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: