Provider Demographics
NPI:1306421706
Name:VARTANYAN, SHIRAK (PHARM)
Entity type:Individual
Prefix:
First Name:SHIRAK
Middle Name:
Last Name:VARTANYAN
Suffix:
Gender:M
Credentials:PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30040 FORD RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2369
Mailing Address - Country:US
Mailing Address - Phone:734-469-2310
Mailing Address - Fax:734-469-2309
Practice Address - Street 1:30040 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2369
Practice Address - Country:US
Practice Address - Phone:734-469-2310
Practice Address - Fax:734-469-2309
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302047675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty