MEDICARE: GRISWOLD PHARMACY INC

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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	5301007747	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2046538	OTHER		PK

General Provider Information

NPI Number	:	1184666752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRISWOLD PHARMACY INC

Provider Business Mailing Address
First Line	:	1411 WASHINGTON BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-1745
Country	:	US
Telephone Number	:	313-237-9000
Fax Number	:	313-237-9961

Provider Business Practice Location Address
First Line	:	1411 WASHINGTON BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-1745
Country	:	US
Telephone Number	:	313-237-9000
Fax Number	:	313-237-9961

Authorized Official
Title or Position	:	OWNER AND PHARMACIST
Name	:	AHMED ANKOUNI
Credential	:	RPH
Telephone Number	:	313-237-9000

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	03/29/2016

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Directions to “GRISWOLD PHARMACY INC ” Practice Location

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