1194121194 NPI number — DR. JUSTIN MICHAEL COMEAU BSPS, PHARMD

Table of content: DR. JUSTIN MICHAEL COMEAU BSPS, PHARMD (NPI 1194121194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194121194 NPI number — DR. JUSTIN MICHAEL COMEAU BSPS, PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COMEAU
Provider First Name:
JUSTIN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
BSPS, PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194121194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 S VAN DYKE RD
Provider Second Line Business Mailing Address:
INPATIENT PHARMACY
Provider Business Mailing Address City Name:
BAD AXE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48413-9615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-269-1531
Provider Business Mailing Address Fax Number:
989-269-2320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 S VAN DYKE RD
Provider Second Line Business Practice Location Address:
INPATIENT PHARMACY
Provider Business Practice Location Address City Name:
BAD AXE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48413-9615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-269-1531
Provider Business Practice Location Address Fax Number:
989-269-2320
Provider Enumeration Date:
11/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  5302040158 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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