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General NPI Number Information
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NPI Number | 1750688784
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Entity Type | Organization
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Legal Business Name | BIG D CORP
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 19460 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48223-1200
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Country | US
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Telephone | 313-533-0560
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Fax | 313-533-0568
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Provider Business Mailing Address
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Address Line | C/O CHRISTOPHER PENCAK PC 27322 23 MILE RD. STE. 7
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City | CHESTERFIELD
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State | MI
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Zip | 48051
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Country | US
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Telephone | 586-598-4650
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Fax | 586-598-4651
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL DYTRI
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Credential |
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Telephone | 586-598-4650
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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 | 5301009518
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License Number State | MI
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