Provider Demographics
NPI:1972263879
Name:VITALE, FLOYD FIORINO (RPH)
Entity type:Individual
Prefix:MR
First Name:FLOYD
Middle Name:FIORINO
Last Name:VITALE
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 1:604 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5105
Mailing Address - Country:US
Mailing Address - Phone:586-489-8392
Mailing Address - Fax:
Practice Address - Street 1:17700 23 MILE RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-1154
Practice Address - Country:US
Practice Address - Phone:586-868-9053
Practice Address - Fax:586-868-9055
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist