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General NPI Number Information
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NPI Number | 1790226843
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Entity Type | Organization
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Legal Business Name | RED CAP PHARMACY 002, LLC
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 2200 S WESTERN AVE STE F
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City | CHICAGO
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State | IL
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Zip | 60608-3816
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Country | US
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Telephone | 313-737-0691
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Fax | 313-286-0220
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Provider Business Mailing Address
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Address Line | 37484 INTERCHANGE DR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48335-1023
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Country | US
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Telephone | 313-737-0691
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Fax | 313-286-0220
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Authorized Official
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Title or Position | CEO
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Name | MIKE SHEHADI
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Credential |
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Telephone | 313-737-0691
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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 |
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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 | 054.020246
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License Number State | IL
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