Organization
PINE KNOB PHARMACY 5 INC
Active
Other names
PINE KNOB SAVMOR PHARMACY 5
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN GRAHAM (MANAGER PHARMACY SERVICES)
(248) 348-1570
Entity
Organization
Contact information
Practice address
10740 DIXIE HWY, DAVISBURG, MI 48350-1123
(248) 620-5222
(248) 625-0314
Mailing address
43155 W 9 MILE RD, NOVI, MI 48375-4190
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301007729
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2364850
OTHER ID NUMBER
—
05
—
2364850
—
MI
Enumeration date
08/27/2006
Last updated
04/15/2008
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