=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962452847
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A L R PHARMCY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25022 W WARREN ST
-----------------------------------------------------
City | DEARBORN HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48127-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-278-8620
-----------------------------------------------------
Fax | 313-278-8839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25022 W WARREN ST
-----------------------------------------------------
City | DEARBORN HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48127-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-278-8620
-----------------------------------------------------
Fax | 313-278-8839
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ROBERT STEPHEN KOMJATHY
-----------------------------------------------------
Credential | R. PH.
-----------------------------------------------------
Telephone | 313-278-8620
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 5301003476
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------