Healthcare Provider Details

I. General information

NPI: 1710590963
Provider Name (Legal Business Name): GOOD HOPE PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19940 CONANT ST STE D
DETROIT MI
48234-1494
US

IV. Provider business mailing address

19940 CONANT ST STE D
DETROIT MI
48234-1494
US

V. Phone/Fax

Practice location:
  • Phone: 313-638-1449
  • Fax:
Mailing address:
  • Phone: 313-638-1449
  • Fax:

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 Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. VALERIE M JONES
Title or Position: PRESIDENT
Credential: RPH
Phone: 313-704-5335