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General NPI Number Information
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NPI Number | 1174055925
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Entity Type | Organization
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Legal Business Name | PRIME PHARMACY LLC
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1948 FORD AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-2308
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Country | US
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Telephone | 734-309-7082
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Fax | 734-309-7039
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Provider Business Mailing Address
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Address Line | 1948 FORD AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192
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Country | US
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Telephone | 734-309-7082
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Fax | 734-309-3039
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMMAD HAMDAN
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Credential |
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Telephone | 734-309-7082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301011147
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License Number State | MI
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