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General NPI Number Information
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NPI Number | 1407903560
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Entity Type | Organization
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Legal Business Name | HIGHLAND ROAD PLAZA LLC
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 213 W MAIN ST
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City | MORENCI
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State | MI
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Zip | 49256-1420
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Country | US
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Telephone | 517-458-2261
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Fax | 517-458-7758
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Provider Business Mailing Address
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Address Line | 6479 WYNDHAM DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-1070
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Country | US
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Telephone | 517-458-2261
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Fax | 517-458-7758
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Authorized Official
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Title or Position | MANAGER
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Name | GEBRE ASHEBIR
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Credential |
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Telephone | 571-274-1037
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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 | 5301001291
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License Number State | MI
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