MEDICARE: CRITTENTON RX 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
1	3336C0003X	Community/Retail Pharmacy	5301011409	MI

General Provider Information

NPI Number	:	1568948891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRITTENTON RX LLC

Provider Business Mailing Address
First Line	:	42370 VAN DYKE AVE STE 105
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-3487
Country	:	US
Telephone Number	:	313-353-9257
Fax Number	:	425-486-6367

Provider Business Practice Location Address
First Line	:	42370 VAN DYKE AVE STE 105
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-3487
Country	:	US
Telephone Number	:	313-353-9257
Fax Number	:	425-486-6367

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NILUPA RAHMAN
Credential	:
Telephone Number	:	313-353-9257

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	07/19/2018

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Directions to “CRITTENTON RX LLC ” Practice Location

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