Healthcare Provider Details

I. General information

NPI: 1134897051
Provider Name (Legal Business Name): ANDREI BOGDAN BARBOLOVICI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 08/19/2026
Certification Date: 09/03/2021
Deactivation Date: 03/04/2025
Reactivation Date: 08/19/2026

III. Provider practice location address

7887 26 MILE RD
WASHINGTON TWP MI
48094-3820
US

IV. Provider business mailing address

7887 26 MILE RD
WASHINGTON TWP MI
48094-3820
US

V. Phone/Fax

Practice location:
  • Phone: 586-677-3438
  • Fax:
Mailing address:
  • Phone: 586-677-3438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303036826
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: