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General NPI Number Information
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NPI Number | 1205908233
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Entity Type | Organization
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Legal Business Name | MICHIGAN SPECIALTY CARE PHARMACY LLC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 01/30/2021
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Provider Practice Location Address
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Address Line | 223 W SILVER LAKE RD
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City | FENTON
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State | MI
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Zip | 48430-2605
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Country | US
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Telephone | 810-629-4002
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Fax | 810-629-5247
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Provider Business Mailing Address
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Address Line | 223 W SILVER LAKE RD
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City | FENTON
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State | MI
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Zip | 48430-2605
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Country | US
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Telephone | 810-629-4002
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Fax | 810-629-5247
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Authorized Official
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Title or Position | OWNER
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Name | SHAHID IMRAN
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Credential |
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Telephone | 810-629-4002
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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 | 5301006847
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License Number State | MI
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