Provider Demographics
NPI:1245525526
Name:ADRAGNA, JODI LYNN (RPH)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:LYNN
Last Name:ADRAGNA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2310 METROPOLITAN PKWY
Mailing Address - Street 2:T-2254
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4209
Mailing Address - Country:US
Mailing Address - Phone:586-698-1028
Mailing Address - Fax:586-698-1031
Practice Address - Street 1:2310 METROPOLITAN PKWY
Practice Address - Street 2:T-2254
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4209
Practice Address - Country:US
Practice Address - Phone:586-698-1028
Practice Address - Fax:586-698-1031
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist