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General NPI Number Information
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NPI Number | 1992257208
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Entity Type | Organization
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Legal Business Name | DISCOUNT RX-PORT HURON LLC
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 4 N ORTONVILLE RD STE B
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City | ORTONVILLE
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State | MI
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Zip | 48462-8693
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Country | US
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Telephone | 248-831-1222
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Fax | 888-821-2293
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Provider Business Mailing Address
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Address Line | 4 N ORTONVILLE RD STE B
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City | ORTONVILLE
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State | MI
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Zip | 48462-8693
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Country | US
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Telephone | 248-831-1222
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Fax | 888-821-2293
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Authorized Official
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Title or Position | OWNER
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Name | KHAJA A.F MOHAMMED
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Credential |
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Telephone | 810-423-4433
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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 | 5301011021
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License Number State | MI
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