Healthcare Provider Details

I. General information

NPI: 1780220806
Provider Name (Legal Business Name): CHRISTIAN PELAYO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26200 GREENFIELD RD
OAK PARK MI
48237-1051
US

IV. Provider business mailing address

26200 GREENFIELD RD
OAK PARK MI
48237-1051
US

V. Phone/Fax

Practice location:
  • Phone: 248-721-4577
  • Fax: 248-721-8051
Mailing address:
  • Phone: 248-721-4577
  • Fax: 248-721-8051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302036851
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5315110667
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: