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General NPI Number Information
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NPI Number | 1568871382
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Entity Type | Organization
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Legal Business Name | PELHAM PHARMACY
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 3815 PELHAM ST SUITE 3
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City | DEARBORN
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State | MI
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Zip | 48124-3852
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Country | US
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Telephone | 313-565-2745
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Fax | 313-565-2747
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Provider Business Mailing Address
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Address Line | 3815 PELHAM ST SUITE 3
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City | DEARBORN
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State | MI
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Zip | 48124-3852
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Country | US
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Telephone | 313-565-2745
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Fax | 313-565-2747
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Authorized Official
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Title or Position | RPH
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Name | MR. MIKE HAIDAR
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Credential |
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Telephone | 313-565-2745
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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 | 5301010530
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License Number State | MI
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