Healthcare Provider Details

I. General information

NPI: 1265843320
Provider Name (Legal Business Name): DOWNRIVER FAMILY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14156 EUREKA RD
SOUTHGATE MI
48195-2055
US

IV. Provider business mailing address

25205 TROWBRIDGE ST
DEARBORN MI
48124-2414
US

V. Phone/Fax

Practice location:
  • Phone: 734-285-0003
  • Fax: 734-285-0274
Mailing address:
  • Phone: 313-995-1174
  • Fax: 734-285-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010426
License Number StateMI

VIII. Authorized Official

Name: BILAL CHAABAN
Title or Position: OWNER
Credential:
Phone: 313-995-1174