| NPI | 1407962442 |
|---|---|
| Doing Business As | PAUL M DERDERIAN DO |
| Entity Type | Organization |
| Authorized Contact | LESLIE NOWAK Practice Manager 586-493-3435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MI 5101009575) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-08-22 |