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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