Organization
DIVINE PHARMACY LLC
Active
Other names
DIVINE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
REMY ONIMOE (OWNER)
(734) 657-1727
Entity
Organization
Contact information
Practice address
16191 LIVERNOIS AVENUE, DETROIT, MI 48221
(313) 651-9059
Mailing address
16191 LIVERNOIS AVENUE, DETROIT, MI 48221-3724
(313) 651-9059
(313) 659-6965
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010794
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003273202
—
MI
01
—
2157415
PK
—
Enumeration date
01/20/2016
Last updated
12/07/2018
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