Individual
MICHELE JOANN ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-1231
Mailing address
18311 CEDAR ISLAND BLVD, BROWNSTOWN, MI 48174-9585
(313) 995-0551
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
3701-0106-0953-552
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3701-0106-0953-552
CERTIFIED PHARMACY TECH
MI
Enumeration date
05/12/2007
Last updated
07/08/2007
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