Healthcare Provider Details

I. General information

NPI: 1093786030
Provider Name (Legal Business Name): MARTHA LINCOLN TJOLSEN B.S. PHARMACY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E BENNETT ST
SALINE MI
48176-1204
US

IV. Provider business mailing address

3016 WINDMILL CT
ADRIAN MI
49221-8201
US

V. Phone/Fax

Practice location:
  • Phone: 734-429-0509
  • Fax: 734-944-1180
Mailing address:
  • Phone: 517-263-7300
  • Fax: 517-263-7370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302025291
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: