Individual
IKHLAS R PUTRUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
23100 CHERRY HILL ST, DEARBORN, MI 48124-1493
(313) 274-5990
(313) 274-1479
Mailing address
23100 CHERRY HILL ST, DEARBORN, MI 48124-1493
(313) 274-5990
(313) 274-1479
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302025677
MI
Other
Enumeration date
09/02/2006
Last updated
07/08/2007
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