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NPI Code Detail

MEDICARE: FLATROCK CITY PHARMACY LLC

MEDICARE: FLATROCK CITY PHARMACY 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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0004XCompounding Pharmacy
43336S0011XSpecialty Pharmacy
53336C0003XCommunity/Retail Pharmacy5301009831MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12376843OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1285995407
Entity Type Code : Organization
Provider Name (Legal Business Name) : FLATROCK CITY PHARMACY LLC
Provider Business Mailing Address
First Line : 25620 GIBRALTAR RD
Second Line :
City : FLAT ROCK
State : MI
Zip : 48134-1243
Country : US
Telephone Number : 734-789-8950
Fax Number : 734-789-8956
Provider Business Practice Location Address
First Line : 25620 GIBRALTAR RD
Second Line :
City : FLAT ROCK
State : MI
Zip : 48134-1243
Country : US
Telephone Number : 734-789-8950
Fax Number : 734-789-8956
Authorized Official
Title or Position : PRESIDENT
Name : MR. MADAN AHEER
Credential :
Telephone Number : 313-737-4946
Provider Enumeration Date : 06/05/2012
Last Update Date : 03/07/2016

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Directions to “FLATROCK CITY PHARMACY LLC ” Practice Location

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