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General NPI Number Information
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NPI Number | 1427439272
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Entity Type | Organization
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Legal Business Name | INDEX MEDS PHARMACY NO-3 LLC
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 28350 GRATIOT AVE
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City | ROSEVILLE
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State | MI
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Zip | 48066-4208
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Country | US
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Telephone | 248-267-6534
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Fax |
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Provider Business Mailing Address
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Address Line | 190 HADSELL DR
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-0408
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Country | US
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Telephone | 248-267-6534
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUNITHA ATLURI
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Credential |
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Telephone | 248-267-6534
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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 | 5315070945
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License Number State | MI
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