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General NPI Number Information
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NPI Number | 1437107448
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL VILLAGE PHARMACY
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 128 COLE RD STE B
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City | MONROE
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State | MI
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Zip | 48162-4104
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Country | US
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Telephone | 734-457-2211
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Fax | 734-457-3738
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Provider Business Mailing Address
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Address Line | 128 COLE RD STE B
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City | MONROE
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State | MI
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Zip | 48162-4104
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Country | US
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Telephone | 734-457-2211
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Fax | 734-457-3738
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Authorized Official
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Title or Position | OWNER
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Name | JOHN BICKING
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Credential | RPH
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Telephone | 734-243-5656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 5301006995
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License Number State | MI
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