Healthcare Provider Details

I. General information

NPI: 1659626646
Provider Name (Legal Business Name): GRAND BLANC COMMUNITY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12741 S SAGINAW ST STE 802
GRAND BLANC MI
48439-2460
US

IV. Provider business mailing address

1230 S LINDEN RD
FLINT MI
48532-3459
US

V. Phone/Fax

Practice location:
  • Phone: 810-953-0710
  • Fax: 810-953-0715
Mailing address:
  • Phone: 810-720-2990
  • Fax: 810-720-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010002
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AHMED ZAKI
Title or Position: CEO
Credential:
Phone: 810-720-2990