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Organization

ISLAND COMPOUNDING PHARMACY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LAURA LILE M.D., R.PH. (OWNER)
(734) 307-7671
Entity
Organization

Contact information

Practice address
24201 MERIDIAN RD, SUITE 1, GROSSE ILE, MI 48138-2134
(734) 307-7671
Mailing address
PO BOX 419, GROSSE ILE, MI 48138-0419

Taxonomy

Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
5301007758
MI

Other

Enumeration date
12/16/2014
Last updated
12/16/2014
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