Healthcare Provider Details

I. General information

NPI: 1275575847
Provider Name (Legal Business Name): CLIO ROAD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 CLIO RD
FLINT MI
48504-1898
US

IV. Provider business mailing address

4902 CLIO RD
FLINT MI
48504-1898
US

V. Phone/Fax

Practice location:
  • Phone: 810-789-7084
  • Fax: 810-789-7088
Mailing address:
  • Phone: 810-789-7084
  • Fax: 810-789-7088

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 Number5301007593
License Number StateMI

VIII. Authorized Official

Name: SELMA DZELIL
Title or Position: VP RDO
Credential: PHARMD.
Phone: 815-715-8502