Healthcare Provider Details

I. General information

NPI: 1104315597
Provider Name (Legal Business Name): YOURX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33136 RYAN RD
STERLING HEIGHTS MI
48310-6462
US

IV. Provider business mailing address

33136 RYAN RD
STERLING HEIGHTS MI
48310-6462
US

V. Phone/Fax

Practice location:
  • Phone: 586-393-5232
  • Fax: 586-393-5250
Mailing address:
  • Phone: 586-393-5232
  • Fax: 586-393-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301011388
License Number StateMI

VIII. Authorized Official

Name: JAWAN DANHO
Title or Position: OWNER/PIC
Credential: PHARMD
Phone: 586-393-5232