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General NPI Number Information
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NPI Number | 1306085394
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Entity Type | Organization
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Legal Business Name | WEST BLOOMFIELD MARKET LLC
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Dates
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Enumeration Date | 02/13/2009
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 6565 ORCHARD LAKE RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3403
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Country | US
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Telephone | 248-626-1111
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Fax | 248-626-1116
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Provider Business Mailing Address
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Address Line | 30777 NORTHWESTERN HWY STE 301
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2549
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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 | VP OF PHARMACY
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Name | JENNIFER MARTIN
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Credential |
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Telephone | 248-706-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301009097
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License Number State | MI
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