Healthcare Provider Details

I. General information

NPI: 1972877876
Provider Name (Legal Business Name): BYRON DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13355 DIX TOLEDO RD
SOUTHGATE MI
48195-1849
US

IV. Provider business mailing address

13355 DIX TOLEDO ROAD
SOUTHGATE MI
48195
US

V. Phone/Fax

Practice location:
  • Phone: 734-283-0100
  • Fax: 734-283-4014
Mailing address:
  • Phone: 813-304-2221
  • Fax: 888-239-8423

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 Number5301009760
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALPESH PATEL
Title or Position: OWNER
Credential:
Phone: 813-304-2221