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General NPI Number Information
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NPI Number | 1083579437
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Entity Type | Individual
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Provider Name | AISWARYA DIVAGARAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/18/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 600 E LAFAYETTE BLVD
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City | DETROIT
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State | MI
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Zip | 48226-2927
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Country | US
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Telephone | 313-225-8285
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Fax |
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Provider Business Mailing Address
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Address Line | 328 DEMPSTER ST APT 2
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City | EVANSTON
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State | IL
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Zip | 60202-1384
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Country | US
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Telephone |
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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 | 5302413756
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License Number State | MI
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