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General NPI Number Information
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NPI Number | 1982700779
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Entity Type | Organization
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Legal Business Name | MEDICINE ROOM
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 72 S. WASHINGTON ST STE 207
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City | OXFORD
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State | MI
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Zip | 48371
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Country | US
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Telephone | 248-628-7990
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Fax | 248-628-6507
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Provider Business Mailing Address
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Address Line | 72 S. WASHINGTON ST STE 207 OXFORD, MI 48371 STE 207
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City | OXFORD
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State | MI
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Zip | 48371
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Country | US
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Telephone | 248-628-7990
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Fax | 248-628-6507
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Authorized Official
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Title or Position | RPH,OWNER
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Name | THERESA CRISP
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Credential |
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Telephone | 810-441-1685
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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 | 5301003591
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License Number State | MI
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