Individual
MR. CHACKO JOSEPH PUTHENTHARAYIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.PHARM
Contact information
Practice address
116 N. MAIN STREET, OLIVET PHARMACY, OLIVET, MI 49076
(692) 805-0052
Mailing address
56507 KEN CHARLES DR, SHELBY TOWNSHIP, MI 48316-6108
(489) 467-7252
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302035928
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5302035928
PHARMACIST
MI
Enumeration date
07/14/2009
Last updated
06/08/2020
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