Healthcare Provider Details

I. General information

NPI: 1285995407
Provider Name (Legal Business Name): FLATROCK CITY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25620 GIBRALTAR RD
FLAT ROCK MI
48134-1243
US

IV. Provider business mailing address

25620 GIBRALTAR RD
FLAT ROCK MI
48134-1243
US

V. Phone/Fax

Practice location:
  • Phone: 734-789-8950
  • Fax: 734-789-8956
Mailing address:
  • Phone: 734-789-8950
  • Fax: 734-789-8956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009831
License Number StateMI

VIII. Authorized Official

Name: MR. MADAN AHEER
Title or Position: PRESIDENT
Credential:
Phone: 313-737-4946