Healthcare Provider Details

I. General information

NPI: 1174907745
Provider Name (Legal Business Name): PRIMEMART PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27177 LAHSER RD SUITE 102
SOUTHFIELD MI
48034-4714
US

IV. Provider business mailing address

27177 LAHSER RD SUITE 102
SOUTHFIELD MI
48034-4714
US

V. Phone/Fax

Practice location:
  • Phone: 248-352-3400
  • Fax: 248-352-2995
Mailing address:
  • Phone: 248-352-3400
  • Fax: 248-352-2995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RENEESHA D PARRISH
Title or Position: OWNER
Credential: RN
Phone: 248-961-4249