Individual
MRS. MANDA LOUISE FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
3390 WEST, TRENTON, MI 48183
(734) 676-6622
(734) 676-4166
Mailing address
15755 PLEASANT AVE, ALLEN PARK, MI 48101-1193
(313) 382-2338
(313) 383-2577
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302025457
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5302025457
PHARMACIST LICENSE NUMBER
MI
Enumeration date
10/19/2006
Last updated
07/08/2007
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