Provider Demographics
NPI:1093032534
Name:POSUNIAK, GARY PHILIP
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:PHILIP
Last Name:POSUNIAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25528 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-3584
Mailing Address - Country:US
Mailing Address - Phone:586-703-1740
Mailing Address - Fax:
Practice Address - Street 1:1026 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1317
Practice Address - Country:US
Practice Address - Phone:248-546-4620
Practice Address - Fax:248-546-8191
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist