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General NPI Number Information
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NPI Number | 1265965735
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Entity Type | Organization
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Legal Business Name | PLYMOUTH CITY PHARMACY LLC
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/21/2017
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Provider Practice Location Address
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Address Line | 41416 ANN ARBOR RD E
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City | PLYMOUTH
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State | MI
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Zip | 48170-8005
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Country | US
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Telephone | 734-578-4113
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Fax | 734-228-6958
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Provider Business Mailing Address
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Address Line | 41416 ANN ARBOR RD E
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City | PLYMOUTH
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State | MI
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Zip | 48170-8005
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Country | US
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Telephone | 734-578-4113
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Fax | 734-451-1830
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Authorized Official
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Title or Position | OWNER/PHARMACIST IN CHARGE
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Name | SOJAN THOMAS
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Credential |
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Telephone | 734-578-4113
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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 | 5301011140
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License Number State | MI
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