Provider Demographics
NPI:1194121194
Name:COMEAU, JUSTIN MICHAEL (BSPS, PHARMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MICHAEL
Last Name:COMEAU
Suffix:
Gender:M
Credentials:BSPS, PHARMD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1100 S VAN DYKE RD
Mailing Address - Street 2:INPATIENT PHARMACY
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9615
Mailing Address - Country:US
Mailing Address - Phone:989-269-1531
Mailing Address - Fax:989-269-2320
Practice Address - Street 1:1100 S VAN DYKE RD
Practice Address - Street 2:INPATIENT PHARMACY
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9615
Practice Address - Country:US
Practice Address - Phone:989-269-1531
Practice Address - Fax:989-269-2320
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5302040158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist