Organization
GRAND BLANC RX LLC
Active
Other names
Abbey Pharmacy - grand blanc
Organization subpart
No
Provider details
NPI number
Authorized official
CANDI TOLF (CONTRACT COORDINATOR)
(248) 862-6148
Entity
Organization
Contact information
Practice address
8483 HOLLY RD STE 202, GRAND BLANC, MI 48439-1840
(810) 344-6422
(810) 344-6421
Mailing address
6689 ORCHARD LAKE RD # 168, WEST BLOOMFIELD, MI 48322-3404
(248) 862-6148
(248) 862-6132
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010813
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124530829
—
MI
01
—
2173228
PK
—
Enumeration date
11/02/2017
Last updated
07/19/2018
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