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General NPI Number Information
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NPI Number | 1528523529
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Entity Type | Individual
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Provider Name | JOEL ORUESEFIETA BOKAN RPH
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Gender | Male
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 13641 E 7 MILE RD STE 2
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City | DETROIT
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State | MI
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Zip | 48205-2257
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Country | US
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Telephone | 586-222-9215
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Fax |
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Provider Business Mailing Address
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Address Line | 29985 LACY DR
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City | WESTLAND
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State | MI
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Zip | 48186-7349
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Country | US
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Telephone | 313-258-1826
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Fax | 947-222-8976
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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 | 5302037796530
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License Number State | MI
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