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General NPI Number Information
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NPI Number | 1073621447
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Entity Type | Organization
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Legal Business Name | JANS DISCOUNT PHARMACY INC
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Dates
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Enumeration Date | 08/27/2006
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 1700 JUNCTION ST
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City | DETROIT
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State | MI
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Zip | 48209-2110
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Country | US
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Telephone | 313-843-8770
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Fax | 313-843-8775
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Provider Business Mailing Address
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Address Line | 43155 W 9 MILE RD
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City | NOVI
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State | MI
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Zip | 48375-4190
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER PHARMACY SERVICES
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Name | STEPHEN GRAHAM
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Credential |
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Telephone | 248-348-1570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301007018
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License Number State | MI
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