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NPI Code Detail

MEDICARE: FLAT ROCK FAMILY PHARMACY LLC

MEDICARE: FLAT ROCK FAMILY PHARMACY LLC
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
13336C0004XCompounding Pharmacy
23336C0003XCommunity/Retail Pharmacy5301009376MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12374154OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1588985105
Entity Type Code : Organization
Provider Name (Legal Business Name) : FLAT ROCK FAMILY PHARMACY LLC
Provider Business Mailing Address
First Line : 25620 GIBRALTAR RD
Second Line :
City : FLAT ROCK
State : MI
Zip : 48134-1243
Country : US
Telephone Number : 734-789-8950
Fax Number : 734-789-8956
Provider Business Practice Location Address
First Line : 25620 GIBRALTAR RD
Second Line :
City : FLAT ROCK
State : MI
Zip : 48134-1243
Country : US
Telephone Number : 734-789-8950
Fax Number : 734-789-8956
Authorized Official
Title or Position : OWNER
Name : RAHUL KOCHHAR
Credential :
Telephone Number : 803-629-5197
Provider Enumeration Date : 06/17/2010
Last Update Date : 07/09/2010

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Directions to “FLAT ROCK FAMILY PHARMACY LLC ” Practice Location

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