Provider Demographics
NPI:1528257946
Name:DEMBO, PATRICE ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:ANN
Last Name:DEMBO
Suffix:
Gender:F
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:G2333 SOUTH CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1147
Mailing Address - Country:US
Mailing Address - Phone:810-744-9733
Mailing Address - Fax:810-744-9765
Practice Address - Street 1:G2333 SOUTH CENTER ROAD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519-1147
Practice Address - Country:US
Practice Address - Phone:810-744-9733
Practice Address - Fax:810-744-9765
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist