Provider Demographics
NPI:1932670502
Name:GAMMON, CHIVONNE MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHIVONNE
Middle Name:MARIE
Last Name:GAMMON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39500 FORD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4311
Mailing Address - Country:US
Mailing Address - Phone:734-983-0548
Mailing Address - Fax:
Practice Address - Street 1:39500 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4311
Practice Address - Country:US
Practice Address - Phone:734-983-0548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist