Healthcare Provider Details

I. General information

NPI: 1639080476
Provider Name (Legal Business Name): SC RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14049 E 13 MILE RD STE 5
WARREN MI
48088-5876
US

IV. Provider business mailing address

14049 E 13 MILE RD STE 5
WARREN MI
48088-5876
US

V. Phone/Fax

Practice location:
  • Phone: 586-366-6071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: D M
Title or Position: OWNER
Credential:
Phone: 586-366-6071