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General NPI Number Information
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NPI Number | 1700271350
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Entity Type | Organization
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Legal Business Name | MILLER ROAD PHARMACY
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 5097 MILLER RD
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City | FLINT
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State | MI
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Zip | 48507-1043
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Country | US
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Telephone | 810-228-3304
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Fax | 810-228-3307
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Provider Business Mailing Address
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Address Line | 5097 MILLER RD
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City | FLINT
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State | MI
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Zip | 48507-1043
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Country | US
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Telephone | 810-228-3304
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Fax | 810-228-3307
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. ABUSUFIAN ELTAIB ELTAHIR
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Credential | PHARMD
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Telephone | 810-228-3304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 5301010651
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 5301010651
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License Number State | MI
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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 | 5301010651
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License Number State | MI
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