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General NPI Number Information
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NPI Number | 1497868905
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Entity Type | Individual
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Provider Name | PRAJESH NANDWANA R.PH
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Gender | Male
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 21777 21 MILE RD
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City | MACOMB
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State | MI
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Zip | 48044-2962
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Country | US
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Telephone | 586-949-2082
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Fax | 586-949-2187
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Provider Business Mailing Address
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Address Line | 15640 LAKESIDE VILLAGE DRIVE APT# 306
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6047
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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 |
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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 | 5302034921
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License Number State | MI
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