Healthcare Provider Details

I. General information

NPI: 1972611341
Provider Name (Legal Business Name): JOY DEX PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3418 JOY RD
DETROIT MI
48206-1949
US

IV. Provider business mailing address

3418 JOY RD
DETROIT MI
48206-1949
US

V. Phone/Fax

Practice location:
  • Phone: 313-894-2250
  • Fax: 313-894-2910
Mailing address:
  • Phone: 313-894-2250
  • Fax: 313-894-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5315016501
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301007832
License Number StateMI

VIII. Authorized Official

Name: MUNIR AWN
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 313-894-2250