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General NPI Number Information
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NPI Number | 1689943359
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Entity Type | Individual
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Provider Name | JESSICA MALE PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 12/23/2011
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Last Update Date | 02/17/2013
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Provider Practice Location Address
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Address Line | 6223 W JEFFERSON AVE
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City | DETROIT
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State | MI
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Zip | 48209
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Country | US
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Telephone | 906-346-5543
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Fax |
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Provider Business Mailing Address
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Address Line | 6331 E JEFFERSON AVE
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City | DETROIT
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State | MI
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Zip | 48207-4317
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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 | 5302037247
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License Number State | MI
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