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General NPI Number Information
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NPI Number | 1598910150
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Entity Type | Organization
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Legal Business Name | HAMTRAMCK MEDICAL PHARMACY LLC
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 3301 HOLBROOK ST STE B
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3519
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Country | US
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Telephone | 313-871-1010
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Fax | 313-871-1011
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Provider Business Mailing Address
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Address Line | 3301 HOLBROOK ST SUITE B
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3519
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Country | US
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Telephone | 313-871-1010
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Fax | 313-871-1011
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Authorized Official
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Title or Position | PIC
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Name | MURSALA AHMED
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Credential |
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Telephone | 313-871-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008994
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License Number State | MI
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