Healthcare Provider Details

I. General information

NPI: 1609924315
Provider Name (Legal Business Name): ERICH T. HOWARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12316 24 MILE RD
SHELBY TOWNSHIP MI
48315-1716
US

IV. Provider business mailing address

12316 24 MILE RD
SHELBY TOWNSHIP MI
48315-1716
US

V. Phone/Fax

Practice location:
  • Phone: 586-254-3568
  • Fax: 586-254-3569
Mailing address:
  • Phone: 586-254-3568
  • Fax: 586-254-3569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302410843
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5301008109
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008109
License Number StateMI

VIII. Authorized Official

Name: MR. ERICH THOMAS HOWARD
Title or Position: OWNER
Credential: R.PH.
Phone: 586-254-3568