Organization
STATE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHUSHBOO PATEL (PRESIDENT)
(810) 280-7293
Entity
Organization
Contact information
Practice address
4501 WOODWARD AVE STE 104A, DETROIT, MI 48201-1890
(313) 832-4970
Mailing address
4501 WOODWARD AVE STE 104A, DETROIT, MI 48201-1890
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301009540
MI
Other
Enumeration date
04/06/2011
Last updated
04/06/2011
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