Organization
RADIENT PHARMACY LLC
Active
Other names
Radient Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
INTSAR ALI (PRESIDENT)
(313) 828-1009
Entity
Organization
Contact information
Practice address
16902 W WARREN AVE, DETROIT, MI 48228-3505
(313) 846-7725
Mailing address
16902 W WARREN AVE, DETROIT, MI 48228-3505
(313) 828-1009
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010139
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2142467
PK
—
Enumeration date
10/10/2013
Last updated
10/26/2013
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