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General NPI Number Information
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NPI Number | 1104938190
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Entity Type | Organization
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Legal Business Name | DETROIT HOPE PHARMACY INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | 24695 COOLIDGE HWY
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City | OAK PARK
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State | MI
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Zip | 48237-1449
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Country | US
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Telephone | 248-542-8888
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Fax | 248-542-8860
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Provider Business Mailing Address
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Address Line | 24695 COOLIDGE HWY
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City | OAK PARK
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State | MI
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Zip | 48237-1449
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Country | US
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Telephone | 248-542-8888
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Fax | 248-542-8860
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Authorized Official
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Title or Position | PRESIDENT
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Name | FAYEZ FARAJ
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Credential | RPH
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Telephone | 313-377-1321
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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 | 5301008438
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License Number State | MI
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