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General NPI Number Information
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NPI Number | 1619410321
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Entity Type | Organization
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Legal Business Name | RED CAP PHARMACY 001 LLC
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 214 N WEST AVE STE A
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City | JACKSON
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State | MI
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Zip | 49201-1903
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Country | US
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Telephone | 517-879-4877
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Fax | 517-879-1873
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Provider Business Mailing Address
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Address Line | 214 N. WEST AVE STE A
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City | JACKSON
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State | MI
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Zip | 49201
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Country | US
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Telephone | 517-879-4877
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Fax | 517-879-1873
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMAD ISSA ABOUKHODR
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Credential |
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Telephone | 517-879-4877
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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 | 5301011054
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License Number State | MI
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