Healthcare Provider Details

I. General information

NPI: 1245348614
Provider Name (Legal Business Name): ST CLAIR PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N RIVERSIDE AVE STE A1
SAINT CLAIR MI
48079-5470
US

IV. Provider business mailing address

43155 W 9 MILE RD
NOVI MI
48375-4190
US

V. Phone/Fax

Practice location:
  • Phone: 810-326-1233
  • Fax: 810-326-2901
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5315012420
License Number StateMI

VIII. Authorized Official

Name: MR. SCOT DOUGLAS SHELDON
Title or Position: PRESIDENT
Credential:
Phone: 810-387-4244