Healthcare Provider Details

I. General information

NPI: 1699007542
Provider Name (Legal Business Name): ROSEDALE COMMUNITY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19220 GRAND RIVER AVE
DETROIT MI
48223-1707
US

IV. Provider business mailing address

PO BOX 532258
LIVONIA MI
48153-2258
US

V. Phone/Fax

Practice location:
  • Phone: 313-531-0100
  • Fax: 313-531-0101
Mailing address:
  • Phone: 313-531-0100
  • Fax: 313-531-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009296
License Number StateMI

VIII. Authorized Official

Name: ZAINAB JAAFAR
Title or Position: PRESIDENT
Credential:
Phone: 734-262-4600