Provider Demographics
NPI:1679919625
Name:HURLEY, JOANN
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:HURLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42433 FORD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3303
Mailing Address - Country:US
Mailing Address - Phone:734-981-3900
Mailing Address - Fax:734-981-7570
Practice Address - Street 1:42433 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3303
Practice Address - Country:US
Practice Address - Phone:734-981-3900
Practice Address - Fax:734-981-7570
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist