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General NPI Number Information
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NPI Number | 1215488689
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Entity Type | Organization
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Legal Business Name | CITIZENS PHARMACY INC
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 15537 SCHOOLCRAFT ST
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City | DETROIT
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State | MI
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Zip | 48227-1755
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Country | US
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Telephone | 313-770-7771
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Fax |
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Provider Business Mailing Address
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Address Line | 15537 SCHOOLCRAFT ST
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City | DETROIT
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State | MI
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Zip | 48227-1755
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Country | US
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Telephone | 313-770-7771
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | NADA JOUDI
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Credential |
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Telephone | 313-855-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 5301011028
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License Number State | MI
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