Healthcare Provider Details

I. General information

NPI: 1699862888
Provider Name (Legal Business Name): GRAND VALUE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 GRAND RIVER AVE
DETROIT MI
48204-2052
US

IV. Provider business mailing address

10920 GRAND RIVER AVE
DETROIT MI
48204-2052
US

V. Phone/Fax

Practice location:
  • Phone: 313-931-0010
  • Fax: 313-934-1658
Mailing address:
  • Phone: 313-931-0010
  • Fax: 313-934-1658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number530100439
License Number StateMI

VIII. Authorized Official

Name: KEVIN WHITE
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 313-931-0010