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General NPI Number Information
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NPI Number | 1568954014
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Entity Type | Organization
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Legal Business Name | PONTIAC GENERAL HOSPITAL PHARMACY INC.
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 50 N PERRY ST STE 100
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City | PONTIAC
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State | MI
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Zip | 48342-2217
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Country | US
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Telephone | 248-859-0020
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Fax | 248-859-0025
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Provider Business Mailing Address
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Address Line | 50 N PERRY ST STE 100
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City | PONTIAC
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State | MI
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Zip | 48342-2217
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Country | US
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Telephone | 248-859-0020
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Fax | 248-859-0025
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE/OWNER
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Name | MANSOOR KHAN
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Credential | PHARM. D.
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Telephone | 586-596-4198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 5301011400
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 5301011400
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 5301011400
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301011400
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License Number State | MI
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