Provider Demographics
NPI:1194895995
Name:GRODMAN, ANDREW M (RPH)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:GRODMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2541 W BLOOMFIELD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3086
Mailing Address - Country:US
Mailing Address - Phone:248-360-9326
Mailing Address - Fax:
Practice Address - Street 1:32910 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1774
Practice Address - Country:US
Practice Address - Phone:248-855-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist