Provider Demographics
NPI:1447625199
Name:LOISELLE, DENNIS
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:LOISELLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 S SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7026
Mailing Address - Country:US
Mailing Address - Phone:810-603-9702
Mailing Address - Fax:810-603-9704
Practice Address - Street 1:6160 S SAGINAW RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7026
Practice Address - Country:US
Practice Address - Phone:810-603-9702
Practice Address - Fax:810-603-9704
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020225101835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist