Provider Demographics
NPI:1689751406
Name:PALAN, DAVID R (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:PALAN
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 1:5638 CEDAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9097
Mailing Address - Country:US
Mailing Address - Phone:734-663-5533
Mailing Address - Fax:
Practice Address - Street 1:1112 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2522
Practice Address - Country:US
Practice Address - Phone:734-663-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034356183500000X
MA20248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist