Healthcare Provider Details

I. General information

NPI: 1134423494
Provider Name (Legal Business Name): WASHINGTON MEDICAL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57850 VAN DYKE RD STE 250
WASHINGTON TOWNSHIP MI
48094-3826
US

IV. Provider business mailing address

57850 VAN DYKE RD STE 250
WASHINGTON TOWNSHIP MI
48094-3826
US

V. Phone/Fax

Practice location:
  • Phone: 586-992-9600
  • Fax: 586-992-9611
Mailing address:
  • Phone: 586-992-9600
  • Fax: 586-992-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
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 Number5301009514
License Number StateMI

VIII. Authorized Official

Name: ALVIN NG
Title or Position: PHARMACIST/OWNER
Credential: PHARMD
Phone: 313-808-0506