Healthcare Provider Details

I. General information

NPI: 1306417514
Provider Name (Legal Business Name): SYLVIA A WASSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 W CENTRE AVE
PORTAGE MI
49024-5334
US

IV. Provider business mailing address

5029 HICKORY POINTE DR
ORCHARD LAKE MI
48323-1516
US

V. Phone/Fax

Practice location:
  • Phone: 269-321-0664
  • Fax:
Mailing address:
  • Phone: 248-231-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302413391
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: