Provider Demographics
NPI:1659498426
Name:COMES, MARK RAYMOND (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RAYMOND
Last Name:COMES
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 1:4830 FOX CRK E
Mailing Address - Street 2:APARTMENT 115
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4932
Mailing Address - Country:US
Mailing Address - Phone:248-635-8539
Mailing Address - Fax:
Practice Address - Street 1:4350 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3506
Practice Address - Country:US
Practice Address - Phone:248-674-9466
Practice Address - Fax:248-674-2230
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist