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General NPI Number Information
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NPI Number | 1659626646
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Entity Type | Organization
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Legal Business Name | GRAND BLANC COMMUNITY PHARMACY LLC
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 12741 S SAGINAW ST STE 802
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City | GRAND BLANC
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State | MI
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Zip | 48439-2460
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Country | US
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Telephone | 810-953-0710
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Fax | 810-953-0715
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Provider Business Mailing Address
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Address Line | 1230 S LINDEN RD
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City | FLINT
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State | MI
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Zip | 48532-3459
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Country | US
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Telephone | 810-720-2990
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Fax | 810-720-2993
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Authorized Official
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Title or Position | CEO
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Name | AHMED ZAKI
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Credential |
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Telephone | 810-720-2990
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301010002
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License Number State | MI
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