Healthcare Provider Details

I. General information

NPI: 1407494644
Provider Name (Legal Business Name): MARIA BURCH REGISTERED PHARMACIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28250 DEQUINDRE RD
WARREN MI
48092-5604
US

IV. Provider business mailing address

37220 MORAVIAN DR
CLINTON TOWNSHIP MI
48036-3602
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-2089
  • Fax: 586-558-3291
Mailing address:
  • Phone: 586-212-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302027588
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: