Healthcare Provider Details

I. General information

NPI: 1255923835
Provider Name (Legal Business Name): SWATHI AGISETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27124 DEQUINDRE RD
WARREN MI
48092-3537
US

IV. Provider business mailing address

48927 FREESTONE DR
NORTHVILLE MI
48168-8005
US

V. Phone/Fax

Practice location:
  • Phone: 586-920-2225
  • Fax:
Mailing address:
  • Phone: 734-262-2144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5315123500
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: