Provider Demographics
NPI:1114292943
Name:MONTEROSSO, VILMA LORENA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VILMA
Middle Name:LORENA
Last Name:MONTEROSSO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2343 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2343 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48302-0254
Practice Address - Country:US
Practice Address - Phone:248-972-0725
Practice Address - Fax:248-972-0570
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist