Provider Demographics
NPI:1477764272
Name:HORN, HORACE II (RPH)
Entity Type:Individual
Prefix:MR
First Name:HORACE
Middle Name:
Last Name:HORN
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17516 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2741
Mailing Address - Country:US
Mailing Address - Phone:313-864-7845
Mailing Address - Fax:
Practice Address - Street 1:22777 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-2152
Practice Address - Country:US
Practice Address - Phone:248-358-0727
Practice Address - Fax:248-358-9394
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist