Healthcare Provider Details

I. General information

NPI: 1821195108
Provider Name (Legal Business Name): TEMPERANCE APOTHECARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8941 LEWIS AVE
TEMPERANCE MI
48182-1656
US

IV. Provider business mailing address

8941 LEWIS AVE
TEMPERANCE MI
48182-1656
US

V. Phone/Fax

Practice location:
  • Phone: 734-847-6788
  • Fax: 734-847-7348
Mailing address:
  • Phone: 734-847-6788
  • Fax: 734-847-7348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5301008093
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008093
License Number StateMI

VIII. Authorized Official

Name: DR. CODIE L SEYMOUR
Title or Position: PHARMACIST
Credential:
Phone: 734-847-6788