Provider Demographics
NPI:1922298611
Name:GATIA, ROX IBRAHIM II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROX
Middle Name:IBRAHIM
Last Name:GATIA
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2799 W. GRAND BLVD
Mailing Address - Street 2:DEPARTMENT OF PHARMACY SERVICES
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-916-7714
Mailing Address - Fax:313-916-1302
Practice Address - Street 1:2799 W. GRAND BLVD
Practice Address - Street 2:DEPARTMENT OF PHARMACY SERVICES
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-916-7714
Practice Address - Fax:313-916-1302
Is Sole Proprietor?:No
Enumeration Date:2007-07-28
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302034159OtherPHARMACIST LICENSE NUMBER