Provider Demographics
NPI:1083909725
Name:DEPPONG, WARREN S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:S
Last Name:DEPPONG
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 1:2850 S INDUSTRIAL HWY
Mailing Address - Street 2:STE 50
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6796
Mailing Address - Country:US
Mailing Address - Phone:734-975-7417
Mailing Address - Fax:734-975-3079
Practice Address - Street 1:2850 S INDUSTRIAL HWY
Practice Address - Street 2:STE 50
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6796
Practice Address - Country:US
Practice Address - Phone:734-975-7417
Practice Address - Fax:734-975-3079
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist