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General NPI Number Information
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NPI Number | 1992676571
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Entity Type | Individual
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Provider Name | PATRISHA PROVIDO
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Gender | Female
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 18640 E 9 MILE RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-1945
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Country | US
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Telephone | 586-447-4370
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Fax |
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Provider Business Mailing Address
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Address Line | 21524 BROADWAY ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1433
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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 | 5302417937
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License Number State | MI
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