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General NPI Number Information
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NPI Number | 1821439621
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Entity Type | Organization
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Legal Business Name | HIGHLAND PARK GLORY PHARMACY LLC
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 23815 NORTHWESTERN HWY STE 120
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City | SOUTHFIELD
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State | MI
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Zip | 48075-7738
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Country | US
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Telephone | 248-996-8441
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Fax | 248-996-8827
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Provider Business Mailing Address
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Address Line | 23815 NORTHWESTERN HWY SUITE 120
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City | SOUTHFIELD
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State | MI
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Zip | 48075-7738
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Country | US
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Telephone | 248-996-8441
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Fax | 248-996-8827
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMED SOHOUBAH
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Credential |
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Telephone | 248-663-3380
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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 | 5301010044
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License Number State | MI
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