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General NPI Number Information
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NPI Number | 1023637873
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Entity Type | Individual
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Provider Name | FLORINA IVAN RPH
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Gender | Female
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 12731 S SAGINAW ST
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City | GRAND BLANC
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State | MI
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Zip | 48439-1830
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Country | US
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Telephone | 810-953-9156
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Fax |
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Provider Business Mailing Address
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Address Line | 7350 N INKSTER RD APT 106
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-1630
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Country | US
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Telephone | 313-580-3804
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302042990
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License Number State | MI
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