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General NPI Number Information
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NPI Number | 1295849214
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Entity Type | Organization
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Legal Business Name | 1616 FORD AVE DRUGS INC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1616 FORD AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-2304
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Country | US
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Telephone | 734-285-3111
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Fax | 734-285-8258
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Provider Business Mailing Address
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Address Line | 1616 FORD AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-2304
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Country | US
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Telephone | 734-285-3111
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Fax | 734-285-8258
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. PETAR DIMOVICH
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Credential | R.PH.
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Telephone | 734-285-3111
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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 | 5301006574
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License Number State | MI
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