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General NPI Number Information
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NPI Number | 1093786030
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Entity Type | Individual
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Provider Name | MARTHA LINCOLN TJOLSEN B.S. PHARMACY
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Gender | Female
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Dates
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Enumeration Date | 01/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 75 E BENNETT ST
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City | SALINE
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State | MI
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Zip | 48176-1204
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Country | US
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Telephone | 734-429-0509
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Fax | 734-944-1180
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Provider Business Mailing Address
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Address Line | 3016 WINDMILL CT
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City | ADRIAN
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State | MI
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Zip | 49221-8201
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Country | US
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Telephone | 517-263-7300
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Fax | 517-263-7370
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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 | 5302025291
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License Number State | MI
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