Healthcare Provider Details

I. General information

NPI: 1073780300
Provider Name (Legal Business Name): MRS. CYNTHIA JEAN GARDINER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6970 N ROCHESTER RD
ROCHESTER MI
48306
US

IV. Provider business mailing address

52839 ANTOINETTE CT
SHELBY TWP MI
48316
US

V. Phone/Fax

Practice location:
  • Phone: 248-651-1614
  • Fax: 248-651-9579
Mailing address:
  • Phone: 586-254-6463
  • Fax: 248-651-9579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number411034
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: