Provider Demographics
NPI:1699041822
Name:FLORENTINE, MAURO J (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MAURO
Middle Name:J
Last Name:FLORENTINE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28500 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1802
Mailing Address - Country:US
Mailing Address - Phone:206-271-6106
Mailing Address - Fax:
Practice Address - Street 1:28500 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 116
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1802
Practice Address - Country:US
Practice Address - Phone:206-271-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020250691835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302025069OtherPHARMACY LICENSE