Healthcare Provider Details

I. General information

NPI: 1518173202
Provider Name (Legal Business Name): LARRY JAMES LUND RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 11/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S GROESBECK HWY
MOUNT CLEMENS MI
48043-2107
US

IV. Provider business mailing address

47150 TILCH RD
MACOMB MI
48044-2456
US

V. Phone/Fax

Practice location:
  • Phone: 586-468-0978
  • Fax:
Mailing address:
  • Phone: 586-566-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302021446
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: