Provider Demographics
NPI:1013285089
Name:BLUESTONE, NEIL L (RPH)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:L
Last Name:BLUESTONE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 HIGHLAND RD # M-59
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1222
Mailing Address - Country:US
Mailing Address - Phone:248-673-2107
Mailing Address - Fax:248-673-2673
Practice Address - Street 1:4400 HIGHLAND RD # M-59
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1222
Practice Address - Country:US
Practice Address - Phone:248-673-2107
Practice Address - Fax:248-673-2673
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist