Healthcare Provider Details

I. General information

NPI: 1588220297
Provider Name (Legal Business Name): KRX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32932 WARREN RD STE C
WESTLAND MI
48185-3095
US

IV. Provider business mailing address

32932 WARREN RD STE C
WESTLAND MI
48185-3095
US

V. Phone/Fax

Practice location:
  • Phone: 734-427-2850
  • Fax: 734-427-3428
Mailing address:
  • Phone: 734-427-2850
  • Fax: 734-427-3428

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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SARAH JAAFAR
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 734-427-2850