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General NPI Number Information
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NPI Number | 1023179843
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Entity Type | Organization
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Legal Business Name | KINGSWAY MEDICAL PHARMACY
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 1675 KINGSWAY CT
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City | TRENTON
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State | MI
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Zip | 48183-1958
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Country | US
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Telephone | 734-493-3127
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Fax | 734-493-3128
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Provider Business Mailing Address
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Address Line | 1675 KINGSWAY CT
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City | TRENTON
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State | MI
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Zip | 48183-1958
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Country | US
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Telephone | 734-493-3127
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Fax | 734-493-3128
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Authorized Official
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Title or Position | PIC
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Name | HUSSIEN HACHOUCHE
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Credential | RPH
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Telephone | 313-641-6483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008548
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License Number State | MI
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