Healthcare Provider Details

I. General information

NPI: 1043783285
Provider Name (Legal Business Name): MEDICAL ARTS PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8483 HOLLY RD STE 202
GRAND BLANC MI
48439-1840
US

IV. Provider business mailing address

8483 HOLLY RD STE 202
GRAND BLANC MI
48439-1840
US

V. Phone/Fax

Practice location:
  • Phone: 810-344-6422
  • Fax: 810-344-6421
Mailing address:
  • Phone: 810-344-6422
  • Fax: 810-344-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN A ALLEN
Title or Position: PIC
Credential: RPH
Phone: 810-344-6422