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
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1841043460
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 STREET
Second Line	:	STE A
City	:	FENTON
State	:	MI
Zip	:	48430
Country	:	US
Telephone Number	:	810-354-8500
Fax Number	:	810-354-8503

Authorized Official
Title or Position	:	PHARMACY OWNER
Name	:	SUKETU MODI
Credential	:
Telephone Number	:	810-354-8503

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	12/11/2025

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