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NPI Code Detail

MEDICARE: RDS DETROIT INC

MEDICARE: RDS DETROIT INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy5301005944MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12351904OTHEROTHER ID NUMBER
22351904OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578672036
Entity Type Code : Organization
Provider Name (Legal Business Name) : RDS DETROIT INC
Provider Business Mailing Address
First Line : 200 NEWBERRY COMMONS
Second Line :
City : ETTERS
State : PA
Zip : 17319-9363
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13240 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48215-2704
Country : US
Telephone Number : 313-331-3343
Fax Number : 313-821-8320
Authorized Official
Title or Position : MANAGER ONLINE ADJUDICATION
Name : JENNIFER ZOREK
Credential :
Telephone Number : 717-975-5937
Provider Enumeration Date : 08/29/2006
Last Update Date : 02/01/2008

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Directions to “RDS DETROIT INC ” Practice Location

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