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General NPI Number Information
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NPI Number | 1609310937
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Entity Type | Organization
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Legal Business Name | NEW SEVEN MILE PHARMACY LLC
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 14400 GRATIOT AVE
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City | DETROIT
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State | MI
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Zip | 48205-2307
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Country | US
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Telephone | 313-245-9920
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Fax | 313-245-9921
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Provider Business Mailing Address
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Address Line | PO BOX 7160
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City | DEARBORN
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State | MI
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Zip | 48121-7160
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Country | US
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Telephone | 313-245-9920
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Fax | 313-245-9921
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Authorized Official
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Title or Position | MEMBER
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Name | FADI FARRAN
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Credential |
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Telephone | 313-245-9920
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301011071
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License Number State | MI
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