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General NPI Number Information
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NPI Number | 1386753846
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Entity Type | Organization
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Legal Business Name | RDS DETROIT INC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 48081 VAN DYKE AVE
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City | SHELBY TWP
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State | MI
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Zip | 48317-3258
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Country | US
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Telephone | 586-731-4242
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Fax | 586-731-1947
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Provider Business Mailing Address
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Address Line | 200 NEWBERRY COMMONS
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City | ETTERS
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State | PA
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Zip | 17319-9363
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER ONLINE ADJUDICATION
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Name | JENNIFER ZOREK
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Credential |
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Telephone | 717-975-5937
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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 | 6041
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License Number State | MI
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