Provider Demographics
NPI:1528433950
Name:JOSHUA, TINA (RPH)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:JOSHUA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2355 CANOE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1882
Mailing Address - Country:US
Mailing Address - Phone:248-393-1110
Mailing Address - Fax:
Practice Address - Street 1:4350 JOSLYN RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-1329
Practice Address - Country:US
Practice Address - Phone:248-391-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034685183500000X
IN26019315A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist