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General NPI Number Information
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NPI Number | 1356564702
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Entity Type | Individual
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Provider Name | JANNA NICOLE REPINE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 215 NORTH AVE
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-1716
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Country | US
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Telephone | 586-466-9650
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Fax | 586-466-9960
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Provider Business Mailing Address
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Address Line | 21379 PINE CONE DR
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City | MACOMB
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State | MI
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Zip | 48042-4336
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Country | US
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Telephone | 765-714-9665
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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 | 5302035452
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 45013462A
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License Number State | IN
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