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Organization
REVIVA COMPOUNDING PHARMACY LLC
Active
Organization
REVIVA COMPOUNDING PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY BEYDOUN PHARMD (OWNER/PHARMACIST IN CHARGE)
(313) 701-2261
Entity
Organization
Contact information
Practice address
1664 FORT ST, LINCOLN PARK, MI 48146-1909
(313) 384-0484
Mailing address
1664 FORT ST, LINCOLN PARK, MI 48146-1909
(313) 384-0484
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Enumeration date
09/18/2026
Last updated
09/18/2026
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