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General NPI Number Information
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NPI Number | 1730207770
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Entity Type | Individual
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Provider Name | SANTOSH MUKTESH PHADKE MS PHARMACOLOGY
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 3 SOUTH TELEGRAPH ROAD
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City | PONTIAC
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State | MI
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Zip | 48341
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Country | US
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Telephone | 248-338-2665
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Fax |
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Provider Business Mailing Address
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Address Line | 633 MILLSTONE DR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-1649
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Country | US
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Telephone | 248-778-6673
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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 | 5302034844
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License Number State | MI
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