Healthcare Provider Details

I. General information

NPI: 1942954318
Provider Name (Legal Business Name): JOSEPH A YOUSIF CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 E 13 MILE RD
WARREN MI
48092-1729
US

IV. Provider business mailing address

4010 E 13 MILE RD
WARREN MI
48092-1729
US

V. Phone/Fax

Practice location:
  • Phone: 586-575-9346
  • Fax:
Mailing address:
  • Phone: 586-575-9346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303037563
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: