Healthcare Provider Details

I. General information

NPI: 1255378055
Provider Name (Legal Business Name): FLINT FAMILY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/03/2020
Certification Date: 10/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G4444 FENTON RD
FLINT MI
48507-3784
US

IV. Provider business mailing address

11271 HARRISON AVE
FARWELL MI
48622-9439
US

V. Phone/Fax

Practice location:
  • Phone: 810-235-7995
  • Fax: 810-235-0241
Mailing address:
  • Phone: 989-339-9008
  • Fax: 855-855-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301002090
License Number StateMI

VIII. Authorized Official

Name: JOHN W GROSS
Title or Position: OWNER
Credential:
Phone: 989-339-9008