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General NPI Number Information
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NPI Number | 1134423957
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Entity Type | Organization
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Legal Business Name | AUBURN DISCOUNT PHARMACY
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Dates
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Enumeration Date | 01/09/2011
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Last Update Date | 01/09/2011
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Provider Practice Location Address
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Address Line | 263 AUBURN AVE
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City | PONTIAC
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State | MI
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Zip | 48342-3012
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Country | US
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Telephone | 313-864-7469
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Fax | 313-864-7607
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Provider Business Mailing Address
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Address Line | 263 AUBURN AVE
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City | PONTIAC
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State | MI
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Zip | 48342-3012
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Country | US
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Telephone | 313-864-7469
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Fax | 313-864-7607
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | DR. MICHAEL O MADU
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Credential | B PHARMS
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Telephone | 678-508-2178
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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 | 5301009491
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License Number State | MI
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