Healthcare Provider Details

I. General information

NPI: 1659583045
Provider Name (Legal Business Name): ROMULUS CITY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23100 CHERRY HILL ST
DEARBORN MI
48124-1493
US

IV. Provider business mailing address

23100 CHERRY HILL ST
DEARBORN MI
48124-1493
US

V. Phone/Fax

Practice location:
  • Phone: 313-274-5990
  • Fax: 313-274-1479
Mailing address:
  • Phone: 313-274-5990
  • Fax: 313-274-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301005869
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JACKLIEN SAHOURIYEH
Title or Position: OWNER
Credential:
Phone: 313-274-5990