Organization
SHELBY CREEK PHARMACY LLC
Active
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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