Provider Demographics
NPI:1518236421
Name:ABRAM, PETRA ANNETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:ANNETTE
Last Name:ABRAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1416
Mailing Address - Country:US
Mailing Address - Phone:231-924-2360
Mailing Address - Fax:
Practice Address - Street 1:819 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1416
Practice Address - Country:US
Practice Address - Phone:231-924-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020393241835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy