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General NPI Number Information
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NPI Number | 1477764272
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Entity Type | Individual
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Provider Name | HORACE HORN II RPH
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 22777 W 11 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48034-2152
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Country | US
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Telephone | 248-358-0727
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Fax | 248-358-9394
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Provider Business Mailing Address
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Address Line | 17516 FAIRFIELD ST
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City | DETROIT
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State | MI
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Zip | 48221-2741
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Country | US
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Telephone | 313-864-7845
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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 | 5302410591
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License Number State | MI
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