Organization
WATERFORD MEDICAL PHARMACY INC
Active
Other names
WATERFORD MEDICAL PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
HOWARD GARVIN (PRESIDENT)
(248) 674-4853
Entity
Organization
Contact information
Practice address
3560 PONTIAC LAKE RD, WATERFORD, MI 48328-2337
(248) 674-4853
(248) 674-3356
Mailing address
3560 PONTIAC LAKE RD, WATERFORD, MI 48328-2337
(248) 674-4853
(248) 674-3356
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301003530
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2329351
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
2329351
—
MI
Enumeration date
08/10/2006
Last updated
10/19/2012
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