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General NPI Number Information
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NPI Number | 1730327784
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Entity Type | Organization
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Legal Business Name | AFAV ENTERPRISES LLC
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Dates
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Enumeration Date | 01/29/2009
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 52366 N MAIN ST
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City | MATTAWAN
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State | MI
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Zip | 49071-9332
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Country | US
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Telephone | 269-668-3366
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Fax | 269-668-3439
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Provider Business Mailing Address
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Address Line | PO BOX 203
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City | MATTAWAN
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State | MI
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Zip | 49071-0203
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Country | US
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Telephone | 269-668-4549
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Fax | 269-668-3439
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA FAVREAU
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Credential |
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Telephone | 269-998-8320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301009053
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License Number State | MI
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