Healthcare Provider Details

I. General information

NPI: 1639766645
Provider Name (Legal Business Name): UNIFIED PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 MOUNT ELLIOTT ST
DETROIT MI
48207-1841
US

IV. Provider business mailing address

2287 ELLSWORTH RD STE A
YPSILANTI MI
48197-4805
US

V. Phone/Fax

Practice location:
  • Phone: 313-579-5502
  • Fax: 313-579-5504
Mailing address:
  • Phone: 734-434-2448
  • Fax: 734-434-2458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEVE SCHEINOST
Title or Position: ADM
Credential:
Phone: 734-434-2448