Healthcare Provider Details

I. General information

NPI: 1699174813
Provider Name (Legal Business Name): FAMILY MEDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S WATER ST
MARINE CITY MI
48039
US

IV. Provider business mailing address

302 S WATER ST
MARINE CITY MI
48039
US

V. Phone/Fax

Practice location:
  • Phone: 312-459-9337
  • Fax:
Mailing address:
  • Phone: 312-459-9337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. DALIA ELGOHARY
Title or Position: PRESIDENT/PHARMACIST IN CHARGE
Credential: RPH
Phone: 312-459-9337