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General NPI Number Information
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NPI Number | 1427076611
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Entity Type | Organization
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Legal Business Name | MONROE STREET PHARMACY, INC.
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 2507 MONROE ST
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City | DEARBORN
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State | MI
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Zip | 48124-3013
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Country | US
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Telephone | 313-274-9141
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Fax | 313-274-9182
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Provider Business Mailing Address
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Address Line | 2507 MONROE ST
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City | DEARBORN
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State | MI
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Zip | 48124-3013
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Country | US
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Telephone | 313-274-9141
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Fax | 313-274-9182
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | MR. ALLIE HAMOOD
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Credential | RPH.
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Telephone | 313-274-9141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 183500000X
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License Number State | MI
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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 | 5301006022
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License Number State | MI
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