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General NPI Number Information
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NPI Number | 1114393196
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Entity Type | Organization
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Legal Business Name | MEDSTOP PHARMACY LLC
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Dates
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Enumeration Date | 08/13/2015
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 10041 FENKELL ST
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City | DETROIT
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State | MI
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Zip | 48238-1643
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Country | US
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Telephone | 313-933-0630
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Fax | 313-933-0632
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Provider Business Mailing Address
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Address Line | 10041 FENKELL ST
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City | DETROIT
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State | MI
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Zip | 48238-1643
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Country | US
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Telephone | 313-933-0630
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Fax | 313-933-0632
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Authorized Official
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Title or Position | OWNER
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Name | BASHEER ALTAIRI
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Credential |
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Telephone | 313-929-7667
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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 |
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License Number State |
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