Healthcare Provider Details

I. General information

NPI: 1245666361
Provider Name (Legal Business Name): RIVER ROUGE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10550 W JEFFERSON AVE
RIVER ROUGE MI
48218-1307
US

IV. Provider business mailing address

10550 W JEFFERSON AVE
RIVER ROUGE MI
48218-1307
US

V. Phone/Fax

Practice location:
  • Phone: 313-438-6825
  • Fax: 313-438-6830
Mailing address:
  • Phone: 313-438-6825
  • Fax: 313-438-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HUSSEIN ELZAGHIR
Title or Position: OWNER/PIC
Credential:
Phone: 313-438-6825