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General NPI Number Information
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NPI Number | 1255324059
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Entity Type | Organization
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Legal Business Name | KD PHARMACY, INC.
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6455 GRATIOT AVE
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City | DETROIT
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State | MI
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Zip | 48207-1808
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Country | US
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Telephone | 313-571-4450
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Fax | 313-571-4451
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Provider Business Mailing Address
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Address Line | 6455 GRATIOT AVE
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City | DETROIT
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State | MI
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Zip | 48207-1808
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Country | US
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Telephone | 313-571-4450
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Fax | 313-571-4451
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. JOHN D'AGNILLO
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Credential | R.PH.
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Telephone | 313-571-4450
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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 | 5301005179
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License Number State | MI
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