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General NPI Number Information
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NPI Number | 1073780300
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Entity Type | Individual
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Provider Name | MRS. CYNTHIA JEAN GARDINER
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Gender | Female
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 6970 N ROCHESTER RD
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City | ROCHESTER
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State | MI
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Zip | 48306
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Country | US
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Telephone | 248-651-1614
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Fax | 248-651-9579
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Provider Business Mailing Address
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Address Line | 52839 ANTOINETTE CT
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City | SHELBY TWP
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State | MI
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Zip | 48316
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Country | US
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Telephone | 586-254-6463
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Fax | 248-651-9579
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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 | 411034
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License Number State | MI
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