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General NPI Number Information
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NPI Number | 1740331701
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Entity Type | Organization
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Legal Business Name | SOUTHFIELD MEDICAL PHARMACY INC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 26699 W 12 MILE RD STE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1578
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Country | US
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Telephone | 248-799-0041
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Fax | 248-799-0043
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Provider Business Mailing Address
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Address Line | 26699 W 12 MILE RD STE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1578
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Country | US
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Telephone | 248-799-0041
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Fax | 248-799-0043
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Authorized Official
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Title or Position | OWNER
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Name | AMY PATEL
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Credential |
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Telephone | 248-799-0041
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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 | 5301008859
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License Number State | MI
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