Healthcare Provider Details

I. General information

NPI: 1518230721
Provider Name (Legal Business Name): 24 HOUR PHARMACY RX STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30801 SCHOENHERR RD STE 500
WARREN MI
48088-6857
US

IV. Provider business mailing address

30801 SCHOENHERR RD STE 500
WARREN MI
48088-6857
US

V. Phone/Fax

Practice location:
  • Phone: 586-619-3950
  • Fax: 586-619-3951
Mailing address:
  • Phone: 586-619-3950
  • Fax: 586-619-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009803
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHENG LOR
Title or Position: OWNER
Credential: PHARMD
Phone: 586-619-3950