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General NPI Number Information
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NPI Number | 1215140009
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Entity Type | Individual
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Provider Name | MR. JASON MATTHEW PATTERSON
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2608
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Country | US
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Telephone | 313-916-1231
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Fax |
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Provider Business Mailing Address
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Address Line | 2397 TRAPPERS AVE.
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City | WINDSOR
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State | ONTARIO
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Zip | N8P1N4
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Country | CA
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Telephone | 519-739-1674
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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 | 5302033195
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License Number State | MI
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