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General NPI Number Information
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NPI Number | 1932502283
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Entity Type | Organization
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Legal Business Name | ARK PHARMACY LLC
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 11250 E JEFFERSON AVE
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City | DETROIT
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State | MI
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Zip | 48214-3301
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Country | US
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Telephone | 313-469-8112
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Fax | 313-499-1329
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Provider Business Mailing Address
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Address Line | 11250 E JEFFERSON AVE
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City | DETROIT
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State | MI
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Zip | 48214-3301
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Country | US
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Telephone | 313-469-8112
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Fax | 313-499-1329
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Authorized Official
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Title or Position | OWNER
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Name | MRS. FATME DAHCHE
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Credential | OWNER
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Telephone | 313-469-8112
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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 | 5301010573
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License Number State | MI
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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 | 5301010573
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License Number State | MI
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