Provider Demographics
NPI:1053689869
Name:CROSS, JAMES BRYCE (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BRYCE
Last Name:CROSS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20100 HAGGERTY RD
Mailing Address - Street 2:T-0872
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1087
Mailing Address - Country:US
Mailing Address - Phone:734-452-0020
Mailing Address - Fax:
Practice Address - Street 1:20100 HAGGERTY RD
Practice Address - Street 2:T-0872
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1087
Practice Address - Country:US
Practice Address - Phone:734-452-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist