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General NPI Number Information
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NPI Number | 1801905476
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Entity Type | Organization
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Legal Business Name | RUSSELLS PHARMACY LLC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 3011 W GRAND BLVD SUITE 107
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City | DETROIT
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State | MI
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Zip | 48202-3096
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Country | US
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Telephone | 313-875-5384
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Fax | 313-875-5490
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Provider Business Mailing Address
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Address Line | 3011 W GRAND BLVD STE 107
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City | DETROIT
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State | MI
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Zip | 48202-3068
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Country | US
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Telephone | 313-875-5384
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Fax | 313-875-5490
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMED A BEYDOUN
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Credential | PHARMD
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Telephone | 313-378-1938
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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 | 5301004374
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License Number State | MI
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