Bi Kakou Marc Eric Djassa, PHARMD
Individual provider Active NPI Pharmacist · Winslow, AZ
NPI 1497959449 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1497959449
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5302037613 (MI)
- Practice address
- 500 Indiana Ave
Winslow, AZ 86047-2169 - Phone
- (928) 289-6118
- Fax
- (928) 289-6293
- NPI assigned
- Jun 13, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302037613 | MI | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302037613 | MI | Yes |
Addresses
Primary practice location
500 Indiana Ave
Winslow, AZ 86047-2169
Mailing address
400 W Maple St
Winslow, AZ 86047-3447
Phone (928) 289-6118
Other providers in Winslow, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.