Organization
GOSHEN PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHUKWUMA ABOMELI (PIC/MANAGER)
(815) 997-0380
Entity
Organization
Contact information
Practice address
16800 GREENFIELD RD UNIT B2, DETROIT, MI 48235-3703
(248) 385-2423
Mailing address
16800 GREENFIELD RD UNIT B2, DETROIT, MI 48235-3703
(313) 340-2882
(313) 340-2884
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215570791
—
MI
01
—
5301011832
PAHRMACY LICENSE
MI
Enumeration date
10/28/2019
Last updated
12/27/2019
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