Basic Information
Provider Information
NPI: 1003156548
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EPSTEIN
FirstName: MARCY
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2400 S TELEGRAPH RD
Address2:  
City: BLOOMFIELD HILLS
State: MI
PostalCode: 483020255
CountryCode: US
TelephoneNumber: 2484091952
FaxNumber: 2484091962
Practice Location
Address1: 2400 S TELEGRAPH RD
Address2:  
City: BLOOMFIELD HILLS
State: MI
PostalCode: 483020255
CountryCode: US
TelephoneNumber: 2484091952
FaxNumber: 2484091962
Other Information
ProviderEnumerationDate: 02/20/2013
LastUpdateDate: 03/01/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/01/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X5302411265MIY Pharmacy Service ProvidersPharmacist 

No ID Information.


Home