Provider Demographics
NPI:1174855340
Name:METZ, JACQUELINE RENEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:RENEE
Last Name:METZ
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 1:40855 ANN ARBOR RD E
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4448
Mailing Address - Country:US
Mailing Address - Phone:734-455-5027
Mailing Address - Fax:734-455-0203
Practice Address - Street 1:40855 ANN ARBOR RD E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4448
Practice Address - Country:US
Practice Address - Phone:734-455-5027
Practice Address - Fax:734-455-0203
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist