Provider Demographics
NPI:1508147729
Name:ROSENBLATT, GARY B (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:B
Last Name:ROSENBLATT
Suffix:
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 1:30762 WOODSTREAM CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1139
Mailing Address - Country:US
Mailing Address - Phone:248-626-4412
Mailing Address - Fax:
Practice Address - Street 1:10081 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2521
Practice Address - Country:US
Practice Address - Phone:810-632-9192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020649183500000X
NY26365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist