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General NPI Number Information
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NPI Number | 1285460469
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Entity Type | Organization
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Legal Business Name | CRESCENT VENTURES GROUP LLC
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 23133 ORCHARD LAKE RD STE 101
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City | FARMINGTON
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State | MI
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Zip | 48336-3278
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Country | US
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Telephone | 248-997-7633
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Fax | 248-997-7633
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Provider Business Mailing Address
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Address Line | 23133 ORCHARD LAKE RD STE 101
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City | FARMINGTON
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State | MI
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Zip | 48336-3278
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Country | US
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Telephone | 248-997-7633
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Fax | 248-997-7633
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MAHDI ELAHI
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Credential |
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Telephone | 248-997-7633
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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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