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General NPI Number Information
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NPI Number | 1558906586
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Entity Type | Organization
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Legal Business Name | VINCENTS RX LLC
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 29619 HARPER AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48082-1640
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Country | US
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Telephone | 313-353-9257
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Fax | 616-333-7674
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Provider Business Mailing Address
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Address Line | 29619 HARPER AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48082-1640
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Country | US
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Telephone | 313-353-9257
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Fax | 616-333-7674
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | NILUPA RAHMAN
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Credential |
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Telephone | 313-353-9257
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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 |
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License Number State |
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