Provider Demographics
NPI:1174043798
Name:SUDHAGAR, BABITHA (RPH)
Entity Type:Individual
Prefix:
First Name:BABITHA
Middle Name:
Last Name:SUDHAGAR
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 1:4525 WALDEN DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1150
Mailing Address - Country:US
Mailing Address - Phone:248-862-6675
Mailing Address - Fax:
Practice Address - Street 1:841 S STATE RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1751
Practice Address - Country:US
Practice Address - Phone:810-653-7485
Practice Address - Fax:810-658-9565
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2017-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302035391OtherPHARMACY LICENSE