Individual
DEBORAH SUE DISTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
512 PHOENIX STREET, SOUTH HAVEN, MI 49090
(269) 637-1161
Mailing address
56667 ORCHARD LANE, BANGOR, MI 49013
(269) 427-5279
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
2215-0902-2083-111
MI
Other
Enumeration date
10/03/2006
Last updated
07/08/2007
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