Provider Demographics
NPI:1457691537
Name:MARQUEDANT, JOSEPH R
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:R
Last Name:MARQUEDANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16177 FAIRWAY ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2109
Mailing Address - Country:US
Mailing Address - Phone:734-542-2191
Mailing Address - Fax:
Practice Address - Street 1:16177 FAIRWAY ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2109
Practice Address - Country:US
Practice Address - Phone:734-542-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist