Provider Demographics
NPI:1891145553
Name:FIGACZ, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FIGACZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44575 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1319
Mailing Address - Country:US
Mailing Address - Phone:586-323-2570
Mailing Address - Fax:586-323-2572
Practice Address - Street 1:44575 MOUND RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1319
Practice Address - Country:US
Practice Address - Phone:586-323-2570
Practice Address - Fax:586-323-2572
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist