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NPI Code Detail

MEDICARE: FENTON PHARMACY RX MI LLC

MEDICARE: FENTON PHARMACY RX MI LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336L0003XLong Term Care Pharmacy

General Provider Information

NPI Number : 1114881448
Entity Type Code : Organization
Provider Name (Legal Business Name) : FENTON PHARMACY RX MI LLC
Provider Business Mailing Address
First Line : 305 N LEROY ST STE A
Second Line :
City : FENTON
State : MI
Zip : 48430-2729
Country : US
Telephone Number : 810-354-8500
Fax Number : 810-354-8503
Provider Business Practice Location Address
First Line : 305 N LEROY ST STE A
Second Line :
City : FENTON
State : MI
Zip : 48430-2729
Country : US
Telephone Number : 810-354-8500
Fax Number : 810-354-8503
Authorized Official
Title or Position : OWNER
Name : SUKETU MODI
Credential :
Telephone Number : 810-354-8500
Provider Enumeration Date : 12/11/2025
Last Update Date : 12/11/2025

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Directions to “FENTON PHARMACY RX MI LLC ” Practice Location

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