Active NPI
Lee Ann Prebola, RPH
- Pharmacist
- Romulus, MI
National Provider Identifier
1457406340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 53020206399
- Practice address
- 36567 Goddard Rd
Romulus, MI 48174-1232 - Phone
- (734) 941-0755
- NPI assigned
- Jan 24, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 53020206399 | MI | Primary |
Addresses
Primary practice location
36567 Goddard Rd
Romulus, MI 48174-1232
Mailing address
19497 Ingram St
Livonia, MI 48152-1589
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53020206399 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457406340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19497 INGRAM ST",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481521589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36567 GODDARD RD",
"city": "ROMULUS",
"state": "MI",
"postal_code": "481741232",
"telephone_number": "734-941-0755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PREBOLA",
"first_name": "LEE ANN",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "53020206399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Romulus, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.