Organization
SPECIALTY MEDICINE COMPOUNDING PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNY RAY WALKUP JR. RPH (OWNER)
(248) 446-2643
Entity
Organization
Contact information
Practice address
350 S LAFAYETTE ST, SOUTH LYON, MI 48178-1814
(248) 446-2643
(248) 486-1906
Mailing address
350 S LAFAYETTE ST, SOUTH LYON, MI 48178-1814
(248) 446-2643
(248) 486-1906
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
5301007610
MI
Other
Enumeration date
12/28/2006
Last updated
04/19/2013
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