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General NPI Number Information
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NPI Number | 1699007542
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Entity Type | Organization
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Legal Business Name | ROSEDALE COMMUNITY PHARMACY INC
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 19220 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48223-1707
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Country | US
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Telephone | 313-531-0100
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Fax | 313-531-0101
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Provider Business Mailing Address
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Address Line | PO BOX 532258
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City | LIVONIA
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State | MI
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Zip | 48153-2258
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Country | US
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Telephone | 313-531-0100
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Fax | 313-531-0101
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Authorized Official
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Title or Position | PRESIDENT
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Name | ZAINAB JAAFAR
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Credential |
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Telephone | 734-262-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 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 #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301009296
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License Number State | MI
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