Healthcare Provider Details

I. General information

NPI: 1386792760
Provider Name (Legal Business Name): ETELRX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21811 KELLY RD STE 103
EASTPOINTE MI
48021-2793
US

IV. Provider business mailing address

21811 KELLY RD STE 103
EASTPOINTE MI
48021-2793
US

V. Phone/Fax

Practice location:
  • Phone: 586-498-7600
  • Fax: 586-498-2011
Mailing address:
  • Phone: 586-498-7600
  • Fax: 586-498-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number5301007233
License Number StateMI

VIII. Authorized Official

Name: GERALD WARNACK
Title or Position: CEO
Credential:
Phone: 586-498-7600