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General NPI Number Information
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NPI Number | 1801022702
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Entity Type | Organization
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Legal Business Name | MICHIGAN SPECIALTY PHARMACY LLC
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 9801 CONANT ST STE A
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3308
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Country | US
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Telephone | 313-467-2130
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Fax | 989-755-7993
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Provider Business Mailing Address
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Address Line | 9801 CONANT ST STE A
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3308
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Country | US
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Telephone | 313-888-9921
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Fax | 313-262-6125
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Authorized Official
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Title or Position | OWNER
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Name | KHAJA MOHAMMED
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Credential |
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Telephone | 313-888-9921
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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 | 5301009130
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License Number State | MI
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