Healthcare Provider Details

I. General information

NPI: 1922690064
Provider Name (Legal Business Name): FENTON PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N LEROY ST STE A
FENTON MI
48430-2729
US

IV. Provider business mailing address

305 N LEROY ST STE A
FENTON MI
48430-2729
US

V. Phone/Fax

Practice location:
  • Phone: 810-354-8500
  • Fax: 810-354-5803
Mailing address:
  • Phone: 810-354-8500
  • Fax: 810-354-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MANISH PATEL
Title or Position: PHARMACY OWNER
Credential:
Phone: 810-354-5800