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General NPI Number Information
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NPI Number | 1144042839
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Entity Type | Organization
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Legal Business Name | PRIME ONE PHARMACY LLC
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 10/27/2024
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Provider Practice Location Address
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Address Line | 24345 NORTHLINE RD STE PHARMACY
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City | TAYLOR
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State | MI
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Zip | 48180-2876
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Country | US
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Telephone | 313-687-1937
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Fax |
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Provider Business Mailing Address
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Address Line | 24345 NORTHLINE RD STE PHARMACY
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City | TAYLOR
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State | MI
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Zip | 48180-2876
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Country | US
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Telephone | 313-687-1937
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | INAS HAIDAR
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Credential |
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Telephone | 313-687-1937
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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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