Healthcare Provider Details

I. General information

NPI: 1174190011
Provider Name (Legal Business Name): EVERYDAY PHARMACY & SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24425 W 9 MILE RD STE 226
SOUTHFIELD MI
48033-0000
US

IV. Provider business mailing address

24425 W 9 MILE RD STE 226
SOUTHFIELD MI
48033-0000
US

V. Phone/Fax

Practice location:
  • Phone: 424-420-5917
  • Fax:
Mailing address:
  • Phone: 424-420-5917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. AUSTIN DERRICK ROGERS
Title or Position: PRESIDENT
Credential:
Phone: 424-420-5917