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NPI Code Detail

MEDICARE: FENTON PHARMACY LLC

MEDICARE: FENTON 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
1333600000XPharmacy
23336C0004XCompounding Pharmacy
33336S0011XSpecialty Pharmacy
43336C0003XCommunity/Retail Pharmacy5301010093MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12140350OTHERPK

General Provider Information

NPI Number : 1609212927
Entity Type Code : Organization
Provider Name (Legal Business Name) : FENTON PHARMACY LLC
Provider Business Mailing Address
First Line : 305 N. LEROY ST
Second Line : SUITE A
City : FENTON
State : MI
Zip : 48430
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 : MANISH PATEL
Credential :
Telephone Number : 813-304-2221
Provider Enumeration Date : 05/14/2013
Last Update Date : 05/30/2023

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Directions to “FENTON PHARMACY LLC ” Practice Location

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