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General NPI Number Information
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NPI Number | 1316220155
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Entity Type | Organization
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Legal Business Name | INTEGRATED DRUG MANAGEMENT
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 26541 PLYMOUTH RD
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City | REDFORD
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State | MI
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Zip | 48239-2214
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Country | US
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Telephone | 313-543-3414
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Fax | 313-543-3416
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Provider Business Mailing Address
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Address Line | 26541 PLYMOUTH RD
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City | REDFORD
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State | MI
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Zip | 48239-2214
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Country | US
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Telephone | 313-543-3414
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Fax | 313-543-3414
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Authorized Official
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Title or Position | CEO
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Name | FAUSTINA IROHA
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Credential |
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Telephone | 248-943-1123
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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 | 5315052908
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License Number State | MI
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