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General NPI Number Information
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NPI Number | 1306137864
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Entity Type | Organization
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Legal Business Name | DEROSSI S PHARMACY LLC
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 15348 FORT ST
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City | SOUTHGATE
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State | MI
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Zip | 48195-1304
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Country | US
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Telephone | 734-246-8800
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Fax | 734-246-8808
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Provider Business Mailing Address
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Address Line | 15348 FORT ST
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City | SOUTHGATE
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State | MI
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Zip | 48195-1304
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Country | US
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Telephone | 734-246-8800
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Fax | 734-246-8808
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Authorized Official
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Title or Position | PRESIDENT
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Name | SACHIN PATEL
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Credential |
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Telephone | 734-246-8800
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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 | 5301009569
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License Number State | MI
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