Organization
WATERFORD MEDICAL PHARMACY INC
Active
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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