Basic Information
| Provider Information | |||||||||
| NPI: | 1114219490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOSEPH | ||||||||
| FirstName: | JOLLY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49650 LAKEBRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | SHELBY TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483153511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867377144 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 860 N VANDYKE | ||||||||
| Address2: | |||||||||
| City: | ALMONT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107988501 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2011 | ||||||||
| LastUpdateDate: | 05/05/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 5302035775 | MI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.