Healthcare Provider Details

I. General information

NPI: 1881782142
Provider Name (Legal Business Name): ANDREW M EFRUSY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22835 VAN DYKE AVE
WARREN MI
48089-2356
US

IV. Provider business mailing address

28733 OAK POINT DR
FARMINGTON HILLS MI
48331-2770
US

V. Phone/Fax

Practice location:
  • Phone: 586-757-6505
  • Fax: 586-757-7785
Mailing address:
  • Phone: 586-757-6505
  • Fax: 586-757-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302022318
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: