Provider Demographics
NPI:1881782142
Name:EFRUSY, ANDREW M (RPH)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:M
Last Name:EFRUSY
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 1:28733 OAK POINT DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2770
Mailing Address - Country:US
Mailing Address - Phone:586-757-6505
Mailing Address - Fax:586-757-7785
Practice Address - Street 1:22835 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2356
Practice Address - Country:US
Practice Address - Phone:586-757-6505
Practice Address - Fax:586-757-7785
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302022318OtherPHARMACIST LICENSE NUMBER