Healthcare Provider Details

I. General information

NPI: 1063071637
Provider Name (Legal Business Name): SMART RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 09/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25464 VAN BORN RD
DEARBORN HEIGHTS MI
48125
US

IV. Provider business mailing address

25464 VAN BORN RD
DEARBORN HEIGHTS MI
48125-1702
US

V. Phone/Fax

Practice location:
  • Phone: 313-530-9595
  • Fax:
Mailing address:
  • Phone: 313-551-4949
  • Fax: 313-436-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLI H CHAYTOU
Title or Position: PHARMACIST
Credential: RPH
Phone: 313-530-9595