Individual
JACK WARREN VANDAHM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1402 W 14 MILE RD, CLAWSON, MI 48017-1499
(248) 435-7314
Mailing address
1402 W 14 MILE RD, CLAWSON, MI 48017-1499
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302042373
MI
Other
Enumeration date
01/30/2020
Last updated
01/31/2020
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