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General NPI Number Information
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NPI Number | 1568455368
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Entity Type | Organization
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Legal Business Name | KD PHARMACY, INC.
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 13820 WOODWARD AVE
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3653
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Country | US
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Telephone | 313-868-5800
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Fax | 313-868-1605
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Provider Business Mailing Address
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Address Line | 2520 INDUSTRIAL ROW DR
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City | TROY
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State | MI
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Zip | 48084-7035
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Country | US
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Telephone | 248-540-8066
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Fax | 248-540-0112
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Authorized Official
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Title or Position | PRESIDENT OF OPERATIONS
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Name | MR. JOHN DEJONGH
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Credential |
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Telephone | 248-540-8066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5301004664
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License Number State | MI
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