Healthcare Provider Details

I. General information

NPI: 1598910150
Provider Name (Legal Business Name): HAMTRAMCK MEDICAL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 HOLBROOK ST STE B
HAMTRAMCK MI
48212-3519
US

IV. Provider business mailing address

3301 HOLBROOK ST SUITE B
HAMTRAMCK MI
48212-3519
US

V. Phone/Fax

Practice location:
  • Phone: 313-871-1010
  • Fax: 313-871-1011
Mailing address:
  • Phone: 313-871-1010
  • Fax: 313-871-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008994
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MURSALA AHMED
Title or Position: PIC
Credential:
Phone: 313-871-1010