Healthcare Provider Details

I. General information

NPI: 1154721520
Provider Name (Legal Business Name): DYNAMIC PHARMACY AND HEALTH SOLUTIONS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E 9 MILE RD
HAZEL PARK MI
48030-1854
US

IV. Provider business mailing address

350 E 9 MILE RD SUITE 2
HAZEL PARK MI
48030-1842
US

V. Phone/Fax

Practice location:
  • Phone: 248-397-8635
  • Fax: 248-397-8970
Mailing address:
  • Phone: 248-397-8635
  • Fax: 248-397-8970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301010564
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010564
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. IFEOMA ODOCHA
Title or Position: PIC/OWNER
Credential: PHARM.D.
Phone: 248-252-3303