Organization
SHELBY CREEK PHARMACY LLC
Active
Other names
Shelby Creek Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KASSEM KOLEIT (PRESIDENT)
(586) 232-4275
Entity
Organization
Contact information
Practice address
8180 26 MILE RD STE 103, SHELBY TOWNSHIP, MI 48316-5129
(586) 232-4275
(586) 232-4296
Mailing address
8180 26 MILE RD, SUITE 103, SHELBY TOWNSHIP, MI 48316-5129
(586) 232-4275
(586) 232-4296
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301009462
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2374902
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/06/2011
Last updated
03/01/2011
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