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General NPI Number Information
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NPI Number | 1851986483
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Entity Type | Individual
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Provider Name | BRIAN ALBERT PHARMACY TECHNICIAN
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Gender | Male
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 4542 KENOWA AVE SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-9523
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Country | US
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Telephone | 616-667-9713
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Fax |
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Provider Business Mailing Address
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Address Line | 5652 E TOWN DR UNIT 2
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City | HUDSONVILLE
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State | MI
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Zip | 49426-8798
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Country | US
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Telephone | 708-515-1012
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 5303020503
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License Number State | MI
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