Provider Demographics
NPI:1013286475
Name:VIJ, SUSHEEL K (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:SUSHEEL
Middle Name:K
Last Name:VIJ
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 RIVER BANK COURT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085
Mailing Address - Country:US
Mailing Address - Phone:248-635-4728
Mailing Address - Fax:
Practice Address - Street 1:215 NORTH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1716
Practice Address - Country:US
Practice Address - Phone:586-307-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist