Healthcare Provider Details

I. General information

NPI: 1235392838
Provider Name (Legal Business Name): SYLVIA VANDERBILT PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13535 SALEM
REDFORD MI
48239-4500
US

IV. Provider business mailing address

13535 SALEM
REDFORD MI
48239-4500
US

V. Phone/Fax

Practice location:
  • Phone: 313-318-8336
  • Fax:
Mailing address:
  • Phone: 313-318-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: