Provider Demographics
NPI:1548670318
Name:BODEEP, DARREN (RPH)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:BODEEP
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 1:8401 26 MILE RD.
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48094
Mailing Address - Country:US
Mailing Address - Phone:586-677-8033
Mailing Address - Fax:586-677-8065
Practice Address - Street 1:8401 26 MILE RD.
Practice Address - Street 2:
Practice Address - City:WASHINGTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48094
Practice Address - Country:US
Practice Address - Phone:586-677-8033
Practice Address - Fax:586-677-8065
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024111021835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy