Healthcare Provider Details

I. General information

NPI: 1952005472
Provider Name (Legal Business Name): PATRICIA HARTING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25610 PONTIAC TRL
SOUTH LYON MI
48178-8046
US

IV. Provider business mailing address

18414 FOCH ST
LIVONIA MI
48152-3813
US

V. Phone/Fax

Practice location:
  • Phone: 248-486-9100
  • Fax:
Mailing address:
  • Phone: 248-565-5119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303014837
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: