Provider Demographics
NPI:1336815547
Name:PATTI, MICHAEL A (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:PATTI
Suffix:
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 1:6751 W DARTMOOR RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4320
Mailing Address - Country:US
Mailing Address - Phone:336-413-2846
Mailing Address - Fax:
Practice Address - Street 1:823 GOLF DR
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-2354
Practice Address - Country:US
Practice Address - Phone:313-600-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024136161835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315228364OtherCONTROLLED SUBSTANCE LICENSE
MI5302413616OtherPHARMACIST LICENSE