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General NPI Number Information
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NPI Number | 1699132779
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Entity Type | Individual
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Provider Name | MR. GARY ROSS PLUMB
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Gender | Male
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 1621 E M 21
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City | OWOSSO
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State | MI
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Zip | 48867-9053
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Country | US
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Telephone | 989-723-2656
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Fax | 989-725-6254
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Provider Business Mailing Address
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Address Line | 1069 WOODVIEW DR
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City | FLINT
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State | MI
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Zip | 48507-4719
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Country | US
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Telephone | 702-372-0687
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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 | 5302410773
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14393
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License Number State | NV
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