Provider Demographics
NPI:1841380680
Name:CONTI, WAYNE P (RPH)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:P
Last Name:CONTI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6401 LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-3423
Mailing Address - Country:US
Mailing Address - Phone:248-651-7114
Mailing Address - Fax:586-775-6555
Practice Address - Street 1:30834 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6856
Practice Address - Country:US
Practice Address - Phone:586-775-1221
Practice Address - Fax:586-775-6555
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5302021515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302021515OtherPHARMACIST LICENSE NUMBE