Provider Demographics
NPI:1528523529
Name:BOKAN, JOEL ORUESEFIETA (RPH)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ORUESEFIETA
Last Name:BOKAN
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 1:29985 LACY DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-7349
Mailing Address - Country:US
Mailing Address - Phone:313-258-1826
Mailing Address - Fax:947-222-8976
Practice Address - Street 1:13641 E 7 MILE RD STE 2
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2257
Practice Address - Country:US
Practice Address - Phone:586-222-9215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037796530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist