Organization
NORTHVILLE PHARMACY LLC
Active
Other names
Northville Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LINA MALLAD (OWNER/PHARMACIST)
(313) 522-7519
Entity
Organization
Contact information
Practice address
116 W MAIN ST, NORTHVILLE, MI 48167-1521
(248) 924-3752
(248) 924-3760
Mailing address
116 W MAIN ST, NORTHVILLE, MI 48167-1521
(248) 924-3752
(248) 924-3760
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009947
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134473713
—
MI
01
—
2377352
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/03/2012
Last updated
11/11/2013
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