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General NPI Number Information
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NPI Number | 1982884318
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Entity Type | Organization
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Legal Business Name | VANDYKE PHARMACY
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 09/12/2008
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Provider Practice Location Address
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Address Line | 27379 VAN DYKE AVE
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City | WARREN
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State | MI
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Zip | 48093-2805
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Country | US
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Telephone | 586-757-9777
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Fax | 586-757-3278
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Provider Business Mailing Address
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Address Line | 27379 VAN DYKE AVE
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City | WARREN
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State | MI
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Zip | 48093-2805
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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 | PRESIDENT
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Name | BIMAL PATEL
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Credential | RPH
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Telephone | 810-410-8460
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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 | 5301008740
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License Number State | MI
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