Organization
GOG PHARMACY PLLC
Active
Other names
Gog Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
FAUSTINA IROHA (OWNER, PIC)
(248) 943-1123
Entity
Organization
Contact information
Practice address
3600 OAKWOOD BLVD, MELVINDALE, MI 48122-1150
(313) 382-3996
(313) 382-3989
Mailing address
30917 WESTWOOD RD, FARMINGTON HILLS, MI 48331-1466
(248) 943-1123
(248) 595-8299
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009829
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154681054
—
MI
01
—
2135464
PK
—
Enumeration date
05/24/2012
Last updated
03/29/2016
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