Healthcare Provider Details

I. General information

NPI: 1578642765
Provider Name (Legal Business Name): JAIME CATHERINE SPELLMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAIME CATHERINE POMA PHARMD

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 HIGHLAND RD SUITE 113
WATERFORD MI
48328-2167
US

IV. Provider business mailing address

4000 HIGHLAND RD SUITE 113
WATERFORD MI
48328-2167
US

V. Phone/Fax

Practice location:
  • Phone: 248-977-1394
  • Fax: 248-977-1395
Mailing address:
  • Phone: 866-850-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302033595
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302033595
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: