=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366033110
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DETROIT PHARMA DISTRIBUTOTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2021
-----------------------------------------------------
Last Update Date | 02/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28000 SOUTHFIELD RD STE 110
-----------------------------------------------------
City | LATHRUP VILLAGE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48076-2864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-327-6527
-----------------------------------------------------
Fax | 248-327-6545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28000 SOUTHFIELD RD STE 110
-----------------------------------------------------
City | LATHRUP VILLAGE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48076-2864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-327-6527
-----------------------------------------------------
Fax | 248-327-6545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PUNAM KUMARI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-327-6527
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------