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General NPI Number Information
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NPI Number | 1538346028
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Entity Type | Organization
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Legal Business Name | ANN ARBOR MARKET LLC
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 375 N MAPLE RD
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City | ANN ARBOR
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State | MI
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Zip | 48103-2824
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Country | US
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Telephone | 734-827-3000
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Fax | 734-827-9445
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Provider Business Mailing Address
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Address Line | 30777 NORTHWESTERN HWY SUITE 301
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2549
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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 | OWNER
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Name | MATT JONNA
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Credential |
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Telephone | 248-706-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008788
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License Number State | MI
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