Organization
MEDSOURCE FAMILY PHARMACY LLC
Active
Organization
MEDSOURCE FAMILY PHARMACY LLC
Active
Other names
MEDSOURCE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
HADI DAGHER RPH (OWNER, PIC, AO)
(313) 717-2900
Entity
Organization
Contact information
Practice address
15300 W 9 MILE RD STE 2, OAK PARK, MI 48237-5200
(248) 850-8594
(248) 629-9839
Mailing address
15300 W 9 MILE RD STE 2, OAK PARK, MI 48237-5200
(248) 850-8594
(248) 629-9839
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301011057
MI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2163895
PK
—
Enumeration date
08/26/2016
Last updated
01/18/2017
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