MEDICARE: DAVIS CUT RATE DRUGS 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
1	3336C0003X	Community/Retail Pharmacy	5301004485	MI

General Provider Information

NPI Number	:	1770594103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIS CUT RATE DRUGS INC.

Provider Business Mailing Address
First Line	:	14039 W. MCNICHOLS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3929
Country	:	US
Telephone Number	:	313-861-9300
Fax Number	:	313-861-3359

Provider Business Practice Location Address
First Line	:	14039 W. MCNICHOLS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3929
Country	:	US
Telephone Number	:	313-861-9300
Fax Number	:	313-861-3359

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MITCHELL AARON WEINER
Credential	:
Telephone Number	:	313-861-9300

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	11/25/2013

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