Organization
SLBTJ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLENE WILLIAMS (OWNER)
(313) 881-3188
Entity
Organization
Contact information
Practice address
16101 MACK AVE, DETROIT, MI 48224-3644
(313) 881-3188
(313) 881-3128
Mailing address
16101 MACK AVE, DETROIT, MI 48224-3644
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5315028304
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2369367
OTHER ID NUMBER
—
Enumeration date
01/17/2007
Last updated
09/12/2007
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