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General NPI Number Information
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NPI Number | 1831720465
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Entity Type | Individual
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Provider Name | VERA PATTAH
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Gender | Female
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Dates
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Enumeration Date | 02/02/2020
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Last Update Date | 02/02/2020
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Provider Practice Location Address
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Address Line | 295 S BROADWAY ST
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City | LAKE ORION
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State | MI
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Zip | 48362-2738
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Country | US
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Telephone | 248-814-6521
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Fax |
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Provider Business Mailing Address
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Address Line | 5006 LEROY CT
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48324-2232
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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 | 5302043388
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License Number State | MI
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