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General NPI Number Information
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NPI Number | 1629961297
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Entity Type | Organization
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Legal Business Name | PURE LIFE PHARMACY LLC
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 1373 DIX HWY
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City | LINCOLN PARK
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State | MI
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Zip | 48146-1346
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Country | US
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Telephone | 313-467-0264
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Fax |
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Provider Business Mailing Address
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Address Line | 820 S PEMBERTON RD
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City | BLOOMFIELD
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State | MI
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Zip | 48302-1443
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Country | US
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Telephone | 313-467-0264
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Fax |
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Authorized Official
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Title or Position | OWNER/PIC
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Name | MR. MOHAMMED IBRAHIM
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Credential | PHARM.D
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Telephone | 313-467-0264
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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 |
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License Number State |
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